Inferior conjunctival bleb-like swelling after amniotic membrane transplant in a patient with a chronic nonhealing corneal ulcer: A case report

We describe a unique case of a healed corneal ulcer following amniotic membrane transplantation (AMT) that resulted in the delayed formation of an inferior bleb-like conjunctival swelling 4 years later, secondary to aqueous humor leakage through a fistulous tract. This report highlights a rare long-term complication of corneal perforation and its sequelae. A 72-year-old female initially presented with a nonhealing corneal ulcer characterized by a large epithelial defect, stromal thinning, iris incarceration, and adherent leucoma. She underwent AMT using the overlay technique, which resulted in successful epithelial healing. The patient was subsequently lost to follow-up and returned 4 years later with complaints of irritation and foreign-body sensation. Slit-lamp examination and anterior segment optical coherence tomography (AS-OCT) were performed for evaluation. On re-examination, she exhibited an irregular leucomatous corneal scar and a diffuse inferior conjunctival bleb-like swelling clinically resembling a cystic elevation. AS-OCT demonstrated a cyst-like space beneath the epithelium with an intact superficial stromal roof, consistent with fluid accumulation through a fistulous tract originating from the previous perforation site. This case illustrates an uncommon late complication following corneal ulceration and AMT, wherein persistent aqueous leakage leads to the development of a fistulous tract and an inferior conjunctival bleb-like lesion. The patient was advised to undergo penetrating keratoplasty (PK) with excision of the bleb-like structure and conjunctival grafting to address both the corneal pathology and conjunctival changes.