Non-surgical Management of Inflammatory Anterior Chamber Hypopyon Post Vitreoretinal Surgery for Proliferative Diabetic Retinopathy

We report two unusual cases of inflammatory anterior chamber hypopyon post vitreoretinal surgery for vitreous hemorrhage secondary to proliferative diabetic retinopathy (PDR). Two out of eight patients operated for proliferative diabetic retinopathy developed hypopyon in the anterior chamber one week post-operative. Case number 2 also had an exudative plaque on the iris and a pupillary membrane. No anterior chamber (AC) entry was made during the primary surgery, and none of the other patients who operated on the same day had a similar reaction to any of the intraocular solutions with the same batch numbers used during the surgery. Physician fitness was taken before surgery, and the diabetic profile of all the patients showed a Hemoglobin A1C of less than 8% and random blood sugar of less than 200 mg/dl. The hypopyon resolved completely with frequent topical steroids and cycloplegics without any cover of topical or systemic antibiotics, suggesting it to be an inflammatory response rather than endophthalmitis. Moreover, neither patient had lid edema and tenderness, which are the hallmark presenting features of acute post-surgical endophthalmitis. We attribute this clinical presentation primarily to the exaggerated inflammatory response to surgery in diabetic retinopathy patients. Since diabetic retinopathy is a condition with raised inflammatory markers, these patients are more prone to an exaggerated inflammatory response to an event like vitreoretinal surgery where various blood ocular barriers could be compromised.