Hypopyon after Primary Cryopreserved Amniotic Membrane Transplantation for Sterile Corneal Ulceration: A Case Report and Review of the Literature

Abstract

Purpose. To report the acute development of hypopyon after primary cryopreserved amniotic membrane transplantation (AMT) for persistent corneal epithelial defect and sterile ulceration. Case Presentation. A selected case report of a 71-year-old male who underwent primary cryopreserved AMT for the management of long-standing corneal epithelial defects and stroma thinning. The patient developed 2 mm sterile hypopyon within 48 hours after AMT for corneal surface reconstruction. He responded well to the intensified routine postoperative topical treatment of steroid and antibiotic eye drops with the hypopyon resolving completely one week later. Five weeks after surgery, the corneal surface was smooth and epithelialized with no anterior chamber reaction or recurrence of hypopyon. Discussion. Hypopyon may develop as a rare complication of primary cryopreserved AMT for sterile corneal defects. It may be attributed to immunologic or hypersensitivity reaction and should be differentiated from active ocular infection as it resolves spontaneously with the routine postoperative topical treatment of steroid and antibiotic drops.

Figure 1

(a) The stromal ulceration was debrided, and the corneal epithelium was removed up to the limbal area. (b) 360° conjunctival peritomy is performed adjacent to limbus. (c) The ulcer was filled up to a surface level with multiple pieces of AM, and a larger AM was transferred to the recipient eye with the epithelial side down. The membrane was trimmed to cover the cornea and limbal area and secured with continuous 10-0 nylon sutures to the conjunctival edges. (d) After suturing, we do a subconjunctival injection with a mixture of dexamethasone and gentamycin. Finally, we place a bandage contact lens to cover the transplanted membrane and cornea.

Figure 2

(a) 3 mm hypopyon formation 2 days after cryopreserved AMT. (b) Regression of hypopyon one week later. (c, d) Clear anterior chamber with healed ocular surface and no signs of inflammation 5 weeks after surgery.