Intracorneal hypopyon within a DSAEK graft.

Introduction: Intracorneal hypopyon is a rare condition involving the accumulation of inflammatory cells and debris within the structures of the cornea. We present an unusual case of an intracorneal hypopyon within a Descemet-stripping automated endothelial keratoplasty (DSAEK) graft.

Patient and clinical findings: A 54-year-old woman status post DSAEK for bullous keratopathy secondary to prior trabeculectomy and cataract surgery developed a corneal ulcer. Corneal cultures grew Serratia marcescens, and topical antibiotics were given. Despite clinical improvement, a dense, deep corneal opacity with overlying epithelial defect persisted.

Diagnosis intervention and outcomes: Anterior segment optical coherence tomography (AS-OCT) identified an intracorneal hypopyon between the Descemet membrane and corneal stroma of the DSAEK graft. Antibiotics were continued, while topical steroids, initially reduced in response to infection, were increased modestly. The patient's condition and hypopyon gradually improved.

Conclusions: Ophthalmologists should consider the possibility of an intracorneal hypopyon masquerading as a persistent stromal infiltrate in the setting of infectious keratitis. Unlike unresponsive corneal infiltrates, intracorneal hypopyons may represent sterile inflammatory debris after resolved infection. AS-OCT was critical to distinguish the intracorneal hypopyon from a persistent infiltrate, which may have prevented unnecessary and/or invasive interventions.