Do Not Fear Failure But Rather Fear Not Trying.

To present a complex case of a patient submitted to multiple anterior and posterior segment surgical procedures in the context of a traumatic event

Ophthalmology Department, Hospital Professor Doutor Fernando Fonseca, Lisbon, Portugal

We describe the case of an 11 year girl that suffered trauma with a rock in her left eye which led to a perforated corneal ulcer and was submitted to a penetrating keratoplasty. Three years later, the patient was attacked with a punch in the same eye, resulting in large dehiscence of the graft, lens extrusion, near complete iridodialysis and vitreous prolapse. In the emergency room, she was submitted to another anterior segment surgery with graft repositioning and was left aphakic and without iris. 4 years later she underwent anterior segment reconstruction with an artificial iris/IOL prosthesis (REPER®)  implantation with 3 points scleral fixation with Prolene 5-0 double flanged (Canabrava). One week after the surgery the patient presented with decentration of the prosthetic device but also with a retinal detachment and was then submitted to a pars plana vitrectomy with silicone oil injection. 6 months later, due progressive opacification of the graft she was submitted to silicone oil extraction, another penetrating keratoplasty associated to suture repositioning of the artificial iris. One month later, due to uncontrolled elevated intraocular pressure the patient underwent Ahmed Valve implantation. Three months postoperatively the eye presents with an IOP of 11 mmHg, visual acuity of 20/100, transparent corneal graft and centered artificial iris/IOL.

Anterior segment surgery in the context of trauma presents unique challenges and a wide range of situations that need to be tackled with skill and perseverance. In this case, multiple procedures were needed but despite all the difficulties, acceptable visual and functional outcomes were obtained.