Management Of Severe Infectious Keratitis With Descemetocele: A Case Report Of Intensive Medical Therapy And Amniotic Membrane Transplantation

Infectious keratitis with subsequent descemetocele formation and hypopyon is a serious ophthalmologic emergency with a high risk of corneal perforation and permanent visual impairment. Prompt diagnosis and aggressive medical intervention are essential to stabilize the ocular surface, contain the infection and prevent further structural compromise.

A 79-year-old patient with glaucoma-related blindness in the left eye (OE) and a previous Ahmed valve implantation presented with a corneal abscess diagnosed one week prior. The patient’s medical history was significant for hypertension. Initial treatment at another facility included topical moxifloxacin (administered every 2 hours); however, microbiologic testing was not performed. On presentation, biomicroscopy revealed a descemetocele (5 mm in size) with an inferior hypopyon (2mm). 

In view of the imminent risk of perforation, intensive fortified topical antibiotic therapy was initiated (vancomycinand ceftazidime hourly) in combination with systemic doxycycline (100 mg twice daily) and moxifloxacin nightly. Vitamin C supplementation was started additionally. Imaging examinations of the anterior segment of the eye and clinical examinations were performed regularly to assess the response to therapy.

An amniotic membrane was placed to promote epithelialization and healing of the stroma.

After two weeks of intensive antimicrobial therapy, the hypopyon regressed and the density of the corneal abscess decreased. At the one-month follow-up visit, residual leukoma was still present, but the descemetocele had improved significantly and there was no evidence of corneal perforation or further progression of the disease. The patient continued to be monitored closely to assess long-term corneal stability and possible visual rehabilitation strategies.

Treatment of severe infectious keratitis with descemetocele formation requires a multidisciplinary approach that includes aggressive drug therapy, close monitoring and adjunctive regenerative techniques such as amniotic membrane transplantation. The lack of microbiologic confirmation in this case highlights the challenge of empiric antimicrobial therapy in the absence of pathogen-directed treatment. Early intervention is critical to preserve corneal integrity and optimize clinical outcomes.