Post-Traumatic Complex Anterior Segment Reconstruction: Nao Explantation, Secondary Nao Implantation And Pupilloplasty In An Artephakic Eye With Corneal Scar And Pupil Ectopia

To describe the surgical management and visual rehabilitation of a post-traumatic eye presenting with artephakia, high myopia, pupil ectopia, corneal scarring, and decentered anterior chamber NAO, managed with NAO explantation, secondary NAO implantation and pupilloplasty.

Tertiary referral center for anterior segment and complex cataract surgery.

A patient with a history of blunt ocular trauma presented with decreased visual acuity, glare, monocular diplopia and cosmetic pupil distortion. Clinical examination revealed artephakia with a previously implanted NAO (non-aligned optic), significant pupil ectopia, irregular astigmatism secondary to corneal scar, and myopic refractive error. Surgical planning aimed to restore optical alignment and pupil centration.

The procedure included explantation of the existing NAO, implantation of a new NAO with improved centration and stability, and simultaneous pupilloplasty using a modified McCannel technique to reconstruct a round, centered pupil. Careful management of fibrotic adhesions and anterior segment instability was required.

Postoperatively, best-corrected visual acuity improved significantly with reduction of photic phenomena and monocular diplopia. The pupil was well-centered with satisfactory cosmetic outcome. The newly implanted NAO remained stable and properly aligned. No intraoperative or early postoperative complications were observed.

Combined NAO exchange and pupilloplasty represents an effective strategy for visual and anatomical rehabilitation in complex post-traumatic anterior segment cases. Individualized surgical planning is essential to optimize refractive and functional outcomes.