Single-Session Quadruple Anterior Segment Reconstruction: Penetrating Keratoplasty, Pars Plana Vitrectomy, Scleral-Sutured Artificial Iris Implantation And Exchange Of Dislocated Iol
Published 2026 - 44th Congress of the ESCRS
Reference: CC01.09 | Type: Case Report | DOI: 10.82333/n6j1-wp15
Authors: Prof. Pantelis A. Papadopoulos* 1 , Dr Alexandros Papadopoulos 1 , Dr Eirini Sinani 2 , Dr Efterpi Chatzispasou 3 , Dr Konstantina Athanasiou 4
11st Ophthalmology Clinic,Athens Metropolitan Teaching Hospital ,Athens,Greece;Ophthalmology Department,University of Nicosia, Athens Branch,Athens,Greece;Ophthalmo-Check Eye Centre,Athens,Greece, 2Ophthalmo-Check Eye Centre,Athens,Greece, 3Ophthalmo-Check Eye Centre,Athens,Greece;Ophthalmology Clinic,Hygeia Hospital,Athens,Greece, 41st Ophthalmology Clinic,Athens Metropolitan Teaching Hospital ,Athens,Greece
Purpose
To describe the surgical technique and 9-month outcomes of a single-session quadruple procedure—penetrating keratoplasty (PK), pars plana vitrectomy (PPV), scleral-sutured artificial iris implantation, and exchange of a posteriorly dislocated intraocular lens (IOL)—for post-traumatic corneal haze, aniridia, and IOL dislocation.
Setting
Athens Metropolitan Teaching Hospital, UNIC Athens, Athens, Greece.
Report of case
We describe the surgical technique and 9-month outcomes of a single-session quadruple procedure—penetrating keratoplasty (PK), pars plana vitrectomy (PPV), scleral-sutured artificial iris implantation, and exchange of a posteriorly dislocated intraocular lens (IOL)—for post-traumatic corneal haze, aniridia, and IOL dislocation.
An 85-year-old man with a history of occupational corneal trauma had undergone PK and cataract surgery 20 years earlier. On presentation, the cornea was markedly hazy, the iris was completely atrophic, and a PMMA IOL was dislocated into the vitreous. Best-corrected visual acuity was counting fingers at 60 cm with severe photophobia. A combined procedure was performed: PPV with removal of the dislocated IOL, implantation of an artificial iris scleral-fixated with Gore-Tex sutures, fixation of a new IOL to the posterior surface of the artificial iris, and PK. No intraoperative complications occurred.
At 9 months, the corneal graft remained clear and the artificial iris–IOL complex was well centered. BCVA improved to 0.8 (decimal notation), and photophobia resolved completely. No postoperative adverse events were observed during follow-up.
Conclusion/Take home message
A single-session quadruple approach combining PK, PPV, artificial iris implantation, and IOL exchange can be safe and effective in complex post-traumatic eyes. This strategy restored ocular anatomy, provided stable centration of the iris–IOL complex, achieved substantial visual rehabilitation, and eliminated disabling photophobia. Meticulous preoperative planning and coordinated anterior–posterior segment surgery are key to success.