About MEAJO | Editorial board | Search | Ahead of print | Current Issue | Archives | Instructions to authors | Online submission | Subscribe | Advertise | Contact | Login 
Middle East African Journal of Ophthalmology Middle East African Journal of Ophthalmology
Users Online: 110   Home Print this page Email this page Small font sizeDefault font sizeIncrease font size


 
  Table of Contents 
CASE REPORT
Year : 2014  |  Volume : 21  |  Issue : 4  |  Page : 361-362  

Intracorneal rhinosporidiosis managed with deep anterior lamellar keratoplasty


1 Department of Ophthalmology, Cornea Services, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
2 Cornea and LASIK Services, Regional Institute of Ophthalmology, Kolkata, West Bengal, India

Date of Web Publication4-Oct-2014

Correspondence Address:
Somnath Mukhopadhyay
402A NSC Bose Road, Kolkata 700 047, West Bengal
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-9233.142282

Rights and Permissions
   Abstract 

A healthy 22-year-old male presented to Institutional Cornea Clinic with an intracorneal mass overlying the pupil with lobulated edges having many tiny greyish white dots. The patient had a history of trauma while swimming in a pond with subsequent removal of intracorneal foreign body in the left eye approximately a year prior to presentation. Anterior segment optical coherence tomography (OCT) confirmed that an intracorneal mass sparing deep stroma and Descemet's membrane. A deep anterior lamellar keratoplasty (DALK) was performed in left eye and the mass was sent for histology examination. Histology evaluation was suggestive of rhinosporidiosis. The patient achieved 20/60 BCVA with -1.25 Χ× 120° 1 year postoperatively without any evidence of recurrence at the graft-host interface. This unique presentation (as an 'intracorneal mass') of ocular rhinosporidiosis emphasizes that clinicians from our region of the world must consider rhinosporidiosis in the differential diagnosis especially with a history of penetrating injury while swimming in pond or river water.

Keywords: Deep Anterior Lamellar Keratoplasty, Ocular Rhinosporidiosis, Rhinosporidiosis


How to cite this article:
Mukhopadhyay S, Datta H, Sen D. Intracorneal rhinosporidiosis managed with deep anterior lamellar keratoplasty. Middle East Afr J Ophthalmol 2014;21:361-2

How to cite this URL:
Mukhopadhyay S, Datta H, Sen D. Intracorneal rhinosporidiosis managed with deep anterior lamellar keratoplasty. Middle East Afr J Ophthalmol [serial online] 2014 [cited 2019 Jun 18];21:361-2. Available from: http://www.meajo.org/text.asp?2014/21/4/361/142282


   Introduction Top


Rhinosporidiosis is a granulomatous disease caused by Rhinosporidium seeberi (earlier described as a fungus, now reclassified in its own class Mesomycetozoea). The disease is more prevalent in Sri Lanka and India due to the widespread custom of bathing in pond water. [1] The disease may involve ear, nose, throat and eye. In the eye, the conjunctiva, lacrimal passage and sclera may be affected. [2] We present a rare manifestation of ocular rhinosporidiosis presenting as an intracorneal mass.


   Case report Top


A healthy 22 year-old male patient reported to the Cornea Clinic of our Institute with a history of gradual dimness of vision in the left eye over the previous 6 months. He had a history of ocular trauma in left eye inflicted while swimming in a pond. Subsequently he was examined by a local ophthalmologist who removed a vegetative foreign body partially embedded in the superficial stroma near the limbus at the 9 o'clock position of left cornea at the slit lamp under topical anesthesia. Presenting vision in left eye was counting fingers close to face and 20/20 in fellow eye. Slit lamp examination of involved eye revealed a large intracorneal mass with lobulated edges. The mass was obstructing the pupil. Many small greyish white dots were noted along the edges of the lesion [Figure 1]. Posterior segment evaluation of the left eye (by B-scan ultrasonography) and the right eye (by slit lamp biomicroscopy) was normal. Intraocular pressure (measured by non-contact method) was normal OU. Anterior segment ocular coherence tomography (Visante TM OCT, software version 3.0.0.139; Carl Zeiss Meditech, Jena, Germany) scan in left eye confirmed the intracorneal nature of the mass (vertical length 0.68 mm and horizontal length 6.52 mm) sparing the deeper part corneal stroma and Descemet's membrane [Figure 2]. We elected for surgical removal of the mass after discussion with the patient. Deep anterior lamellar keratoplasty was performed under peribulbar anesthesia with sedation, layer-by-layer dissection of the stromal layers was performed until exposure of Descemet's membrane. A 9.0-mm donor lenticule whose DM-endothelial layers had been stripped off was sutured to the recipient bed with 16 interrupted 10:0 monofilament nylon sutures. He was discharged with standard postoperative regimen of topical moxifloxacin (0.5%) four times a day and prednisolole acetate (1%) six times a day with gradual tapering. The patient was seen the following day and the graft was clear with good graft-host apposition.
Figure 1: Slit lamp photograph of intracorneal mass

Click here to view
Figure 2: Anterior segment optical coherence tomography image showing an intracorneal lesion

Click here to view


The intracorneal mass was fixed in 10% formol-saline, processed for paraffin embedding and subsequent staining of 4-5-μm sections with the hematoxylin and eosin (H and E) stain. The slide showed many sporangias of varying sizes containing spores. Some empty sporangias were documented. Proliferated stratified epithelium was covering the fibro-cellular tissue. The histology findings were suggestive of rhinosporidiosis [Figure 3]. His postoperative period was uneventful with clear graft, good graft-host apposition and BCVA of 20/60 with -1.25 Χ× 120° 1 year postoperatively. There was no evidence of recurrence at the interface at the 1-year postoperative visit.
Figure 3: Histopathological slide showing multiple encapsulated sporangia (Hematoxylin-Eosin stain, magnification ×10)

Click here to view



   Discussion Top


Rhinosporidiosis is prevalent in India and Sri Lanka due to common practice of bathing in river and pond water. Conjunctival polypoidal mass is the classic presentation in the eyes. Involvement other than eye and ear had been reported in Africa. [3] Trophocyte of R seeberi gives rise to mature sporangium which are seen as white punctuate dots through submucosa. From mature sporangium, endospores (the infective unit) are released and they usually produce the classic lesion of rhinosporidiosis upon entry through a breach in the epithelium on the mucosal surface of the body. In the current case, we assumed that the endospores found a portal into the corneal stroma when the left eye was injured while swimming in pond water resulting in intracorneal foreign body.

Our literature search did not find any cases describing intracorneal involvement of rhinosporidiosis. Ocular rhinosporidiosis might be a rare differential diagnosis of intracorneal mass lesion as presented in this case report.

 
   References Top

1.Thakur SK, Sah SP, Badhu BP. Oculosporidiosis in eastern Nepal: A report of five cases. Southeast Asian J Trop Med Public Health 2002;33:362-4.  Back to cited text no. 1
    
2.John SS, Mohandas SG. Conjunctival oculosporidiosis with scleral thinning and staphyloma formation. Indian J Ophthalmol 2005;53:272-4.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.Gigase P, Kestelyn P. Further African cases of rhinosporidiosis. Ann Soc Belg Med Trop 1993;73:149-52.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

Top
  
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
   Case report
   Discussion
    References
    Article Figures

 Article Access Statistics
    Viewed1062    
    Printed35    
    Emailed0    
    PDF Downloaded92    
    Comments [Add]    

Recommend this journal