Misloaded IOL rips open the posterior capsule

An anonymous surgeon submitted a video of a complication that happened with a misloaded IOL injector. We are thankful for this submission because it allows all of us to learn from this situation. The primary issue is that the lens injector was not filled with a sufficient amount of viscoelastic, which is required for proper lubrication. When the surgeon goes to inject the IOL, a lot of resistance is met and then all of a sudden, it gives and the IOL shoots into the eye quite forcefully.

We have seen a similar case here, but with a luckier outcome and we know that the IOL can get damaged from being misloaded. Even a perfectly loaded IOL can get compression fractures from passing through the injector tip.

In this case, the surgeon has a decision to make: with an open posterior capsule, should the single-piece acrylic IOL be explanted or can it be sufficiently supported? Remember that we cannot place a single-piece acrylic lens in the sulcus. In this case, an anterior vitrectomy is done and the IOL is rotated 90 degrees to an area of sufficient support.

Click below to learn from this well-managed complication:


  1. Very informative video. Great learning opportunity. Many thanks to you and your team. From Dr Varma, Mauritius

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