Tectonic Corneoscleral Graft for Acanthamoeba Keratitis

In this surgical video, Drs. David Warner and Kinza Ahmad use a tectonic corneoscleral graft to manage a case of corneal melt due to severe acanthamoeba infection. The surgeons decided to perform the procedure after the patient continued to worsen slowly during a 2-month period despite an intensive drug regimen. The graft was secured using 8-0 nylon sutures, with the secured area used as a hinge to reflect back the graft. The surgeons excised the melted, native cornea and removed the inflamed membrane over the iris and pupil. The native conjunctiva was mobilized, moved anteriorly and secured to the scleral graft, and an amniotic membrane was secured over the graft. These steps were repeated for all 4 conjunctival quadrants. After treatment, one eye improved to and maintained counting fingers for 6 months. The other eye required reoperation due to graft failure, eventually requiring enucleation.

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