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Introduction Severe penetrating ocular trauma often results in poor visual outcome. Visual rehabilitation in such eyes may be challenging in a monocameral eye with endothelial failure. Combined artificial iris insertion with intraocular lens (IOL) and endothelial keratoplasty offers the potential to rehabilitate the vision by replacing the lost intraocular structures. This video presents a surgical approach in an eye with aphakic bullous keratopathy and complete aniridia.Methods An 89-year-old bilaterally pseudophakic woman with high myopia and bilateral myopic macular degeneration sustained blunt trauma to the left eye in April 2024, resulting in globe rupture. Primary repair at another centre included globe repair with anterior vitrectomy. Postoperatively, she was left aphakic with complete traumatic aniridia and aphakic bullous keratopathy, with vision reduced to hand movements. Secondary glaucoma developed and was managed medically. Vision in the fellow eye was limited to 0.70 logMAR due to macular disease. In June 2025, she underwent a combined triple procedure comprising scleral-sutured HumanOptics artificial iris with a three-piece Sensar intraocular lens using 9-0 Gore-Tex sutures, together with ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK).Results The postoperative course was uncomplicated. At 6 months, unaided visual acuity in the left eye was 0.42 logMAR, improving to 0.34 with pinhole. Intraocular pressure remained stable, with no change in pre-existing glaucoma medication. Corneal clarity was maintained, and the artificial iris–IOL complex remained well centred.Discussion This case demonstrates that triple anterior segment reconstruction can achieve meaningful visual rehabilitation and ocular stability in a severely traumatised eye.