Hypopyon After Amniotic Membrane Transplantation

Abstract

Abstract: : Purpose: To report on hypopyon formation as a rare complication following amniotic membrane transplantation (AMT) onto the cornea in combined surgical procedures. Method: An amniotic membrane was transplanted in combination with a cadaver limbal allograft in 4 patients with limbal insufficiency due to various causes. In 8 patients (9 eyes) a lamellar or penetrating keratoplasty was performed before or concomitantly with AMT. The amniotic membrane was prepared and handled in the usual sterile fashion, cultures of the storage medium were negative. Accidental corneal perforation during the procedure could be excluded. Results: In one patient suffering from GVHD after bone marrow transplantation a hypopyon developed 3 days postoperatively following AMT 7 months after penetrating keratoplasty. In a second patient with severe atopy a hypopyon was observed 4 weeks after combined limbal allograft-AMT. It was associated with signs of limbal transplant rejection. In both patients the hypopyon resolved three to five days later with topical steroid and antibiotic treatment. Conclusion: A local immune response after sensitization to foreign antigens is the most reasonable explanation for hypopyon formation after AMT onto the cornea. In our patients the immune reaction was possibly initiated by non-matched transplanted corneal/limbal tissue and a suspected systemic immune deviation. Special care should be executed in these patients after a combination of procedures which may sensitize the ocular immune system.

Keywords: 369 cornea: clinical science • 372 cornea: epithelium