This report details a case of a 78-year-old male patient who underwent insertion of a HumanOptics artificial iris(CustomFlex®) with scleral fixation following severe ocular trauma, leading to the complete loss of the iris(aniridia). The patient had a pre-existing scleral fixated intraocular lens(IOL) due to prior complicated cataract surgery.

Case Description The patient with a background of angle-closure glaucoma underwent left cataract surgery, encountering an unstable lens and vitreous prolapse, resulting in a vitrectomy and insertion of a gortex-sutured IOL in May 2021. A traumatic event in August 2021 affecting the same eye resulted in complete aniridia in the left eye which reduced the patient’s vision to 6/30, and caused constant glare symptoms.

Outcome and Conclusion The patient underwent scleral fixation of the iris in September 2023. Due to the presence of the pre-existing sutured IOL sited approximately 2.8mm posterior from the limbus, the iris implant was fixated at 1.8mm posterior to the limbus. The surgery achieved excellent anatomical results and improved symptoms. However, there was a persistently high intraocular pressure(IOP)(maximal IOP = 50 mmHg) despite maximal medical management necessitating Ahmed valve implantation in November 2023. Visual acuity improved from 6/30 pre-op to 6/19 postoperatively and at last review IOP was 8 on no medications. This report highlights the complexities and challenges faced in managing traumatic aniridia with an already in situ scleral fixated implant.