AN "AMERICAN HORROR STORY": TECTONIC CORNEOSCLERAL GRAFT /ANTERIOR SEGMENT RECONSRUCTION FOR TOTAL CORNEAL NECROSIS FROM PSEUDOMONAL INFECTIOUS KERATITIS

To show surgical intervention for total corneal necrosis from limbus to limbus Pseudomonal keratitis with tectonic corneoscleral graft and anterior chamber reconstruction in this difficult setting.

Emergency corneal surgery in the hospital setting

Elderly white female presents to ED with total corneal necrosis from infectious keratitis related to contact lens wear. This is the third case of total corneal necrosis we have been involved with in one year. The patient was admitted to the hopsital for fortified topicals and intravitreal injection for suspected endophthalmitis.  Cultures showed this to be Psuedomonas species. The corneal necrosis was limbus to limbus and quickly developed a descemetocele requiring tectonic corneal scleral graft to save the eye. Given the scleritis/ conjunctivitis as well as the total corneal necrosis, the case was quite challenging.  I will show a video of the surgery. This surgery saved the eye and preserved functional vision for later possible visual rehabilitation. 

Tectonic corneoscleral grafting, while challenging,  is an option for total corneal necrosis from infectious keratitis to preserve the eye and functional vision.