Which way should you rotate the IOL, clockwise or counter-clockwise? The answer is… it depends. If the IOL haptics are still tucked and not yet unfolded, then the IOL can easily rotate in either direction. However, if the haptics have opened, then it is far easier (and safer) to rotate the IOL in a clockwise manner.
This is because of the orientation of the haptics are in the anti-S formation. When we try to rotate the IOL counter-clockwise, especially if the capsular bag is not inflated with viscoelastic, the haptic tips can get stuck at the capsular bag equators. If sufficient force is attempted, the haptic tip can even pierce the capsular bag, further complicating the situation.
This is why we initially position a toric IOL a clock hour or two before the desired axis — so we can gently dial it clockwise into the perfect alignment.
Click below to watch the video of the explanation of which way to rotate the IOL: