In this video Nicole Scripsema, MD, highlights the techniques used in the management of a perforating injury with retinal incarceration and aniridia. The patient underwent open globe injury repair for what was suspected to be an isolated zone 1 penetrating injury. Dr. Scripsema reclassified the open globe injury as a zone 3 perforating injury, and performed a secondary repair using a 23-gauge vitrectomy system. The retina was attached under air after freeing up the retina from the incarceration site. Prior to silicone oil injection, silicone oil retention sutures were placed to keep the oil from entering the anterior chamber. Two interlocking triangular retention sutures were used to simulate an iris diaphragm and 6 months postoperatively, the patient’s vision was 20/70 with a hard contact lens.