Interface Hypopyon After Dsaek: Diagnostic Challenge And Successful Surgical Management
Published 2026 - 44th Congress of the ESCRS
Reference: POCOR109 | Type: Case Report | DOI: 10.82333/9104-pw06
Authors: Dr Aparna Namdev Nayak* 1 , Dr Krishna Prasad Kudlu 2 , Dr Sanjana Vatsa 3
1Cornea and Phaco-refractive,Prasad Netralaya,Udupi,India, 2Phaco-refractive,Prasad Netralaya,Udupi,India, 3Cornea and Phaco-refractive,Agarwals Eye Hospital,Bengaluru,India
Purpose
To describe a rare case of localized interface hypopyon occurring between the donor lenticule and host stroma following Descemet Stripping Automated Endothelial Keratoplasty (DSAEK), highlight its diagnostic challenges, and outline the successful surgical and medical management leading to favourable anatomical and visual outcomes.
Setting
Tertiary eye care centre in South India specializing in corneal transplantation and advanced anterior segment surgery.
Report of case
An 80-year-old pseudophakic diabetic male presented with redness and decreased vision of five days duration in his left eye, three months after uneventful DSAEK. Slit-lamp examination showed lid edema, circumcorneal congestion, anterior chamber reaction, and a 2 mm hypopyon localized at the graft–host interface along the visual axis. The posterior chamber intraocular lens was well positioned and fundus evaluation showed no evidence of endophthalmitis.
Anterior segment OCT confirmed a discrete hyperreflective collection confined to the interface between the donor lenticule and host stroma. Given the risk of interface infection, urgent surgical intervention was undertaken. The lenticule was explanted, followed by anterior chamber wash, posterior corneal irrigation and intracameral moxifloxacin administration. Microbiological analysis of the lenticule showed no growth on culture, suggesting a sterile inflammatory process.
Following complete clinical resolution, repeat DSAEK was performed two weeks later. On follow-up, the graft remained clear and well attached with a best-corrected visual acuity of 6/18. The patient remained infection-free with optimized systemic glycemic control.
Conclusion/Take home message
Interface hypopyon after DSAEK is an uncommon but vision-threatening complication. Differentiating infection from sterile inflammation can be challenging. Early recognition, prompt surgical explantation and targeted antimicrobial therapy are critical to prevent further damage. Timely repeat endothelial keratoplasty can achieve favourable visual rehabilitation