ABSTRACT
Stromal keratitis and iritis developed in the left eye of a healthy 45-year-old man with no history of ocular disease, trauma, or contact lens wear. The clinical course over a 2-year period was characterized by progressive central disciform keratitis, recurrent anterior stromal patchy infiltration, and iritis which was partially controlled with topical corticosteroids and broad-spectrum antibiotics. Results of bacterial, viral, fungal, and chlamydial cultures were negative. Results of histopathologic examination of a corneal biopsy specimen and, later, a penetrating keratoplasty specimen showed many extracellular and intracellular spores in degenerating keratocytes. By electron microscopy there were encapsulated oval structures measuring approximately 3.5 to 4 microns in length x 1.5 microns in width. Mature spores had well-developed cell walls that contained two abutted nuclei (diplokaryon) and a redundant polar tubule with six coils. These structures are characteristic of a protozoa in the genus Nosema.
Subject(s)
Corneal Diseases/parasitology , Eye Infections, Parasitic/diagnosis , Protozoan Infections/diagnosis , Animals , Corneal Diseases/diagnosis , Corneal Diseases/pathology , Corneal Diseases/surgery , Eukaryota/isolation & purification , Eukaryota/ultrastructure , Eye Infections, Parasitic/pathology , Eye Infections, Parasitic/surgery , Humans , Iritis/parasitology , Keratitis/parasitology , Keratoplasty, Penetrating , Male , Middle Aged , Protozoan Infections/pathology , Protozoan Infections/surgeryABSTRACT
Patients with nystagmus and an eccentric null point in lateral gaze may assume an abnormal head position to maximise visual acuity. Surgical procedures for this condition can result in significant undercorrection of the head turn. A follow-up of 15 patients for an average of 33 months revealed a sustained improvement in head position with the use of the augmented modified Kestenbaum procedure.
