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This is a very unique case of a high myopic young patient referred to our department due to photophobia and visual disturbance immediately following a previous phakic IOL exchange surgery, resulting in a fixed dilated pupil, corresponding to the rare Urrets-Zavalia syndrome. Apparently the patient had underwent phakic toric iris-claw IOL (Artiflex) more than 2 years before, then LASIK and PRK a few months later to improve residual error, and one year later the attending surgeon decided to exchange the phakic IOL, which resulted in Urrets-Zavalia syndrome. Due to unresolving symptoms and a persisting fixed dialted pupil. The patient was referred for pupilloplasty. to perform the pupil reconstruction we ahd to explant the iris-claw IOL in place and exchange for a newly calculated IOL We describe the technique for pupilloplasty using siepser sliding knot, and the correct sequence for toric Artiflex phakic IOL implantation We hope you enjoy this unique and challenging case. Don't froget to like the video and subscribe the channel, as we will uplaod more videos soon ;) #ophthalmology #refractive #cornea #cataract