When Sclera Fails: Emergency Yamane Fixation And Wide Scleral Patch Grafting In Shawaf–Traboulsi Syndrome

To report the management of a rare emergency presentation of Shawaf–Traboulsi syndrome with acute ectopia lentis causing pupillary block glaucoma in the presence of focal superior scleral thinning and uveal prolapse, and to describe delayed salvage using a large scleral patch graft.

Tertiary eye hospital in Baghdad, Iraq

A patient with Shawaf–Traboulsi syndrome presented with sudden lens dislocation resulting in pupillary block glaucoma. Anterior segment examination revealed superior scleral thinning associated with uveal tissue prolapse. Emergency surgical intervention was undertaken, consisting of lensectomy followed by secondary posterior chamber intraocular lens implantation using Yamane double-needle intrascleral haptic fixation (ISHF). Two discrete areas of clinically healthy sclera were carefully identified and used for haptic externalization, avoiding the thinned scleral region.
Postoperative follow-up demonstrated progressive pupil decentration. Further evaluation revealed incarceration of the iris root within the superior scleral thinning pouch, with worsening uveal prolapse and signs of impending scleral perforation. A secondary reconstructive procedure was performed using a tectonic scleral patch graft spanning approximately 140 degrees to reinforce the weakened sclera and release the incarcerated uveal tissue.
Following scleral patch graft implantation, scleral integrity was restored, uveal tissue was adequately supported, and the pupil returned to a centered position. Anterior segment anatomy remained stable on subsequent follow-up.

Shawaf–Traboulsi syndrome may present with simultaneous lens instability and severe localized scleral fragility. Yamane ISHF can be safely performed when fixation sites are limited to healthy sclera. Large tectonic scleral patch grafting is an effective salvage strategy to prevent perforation and restore anterior segment anatomy.