An anterior chamber IOL (ACIOL) is rarely used, but in cases with no capsular support, it can be very helpful to restore vision to our patients. When we place the ACIOL in the eye, it is important to have it in the correct orientation. Looking at the photo above, which orientation is correct?
We have previously shown cases where the PCIOL was mis-loaded in the injector and intra-ocular maneuvers were required to place the IOL in the eye correctly. We learned from that instructional case that the PCIOL should be in the Z-formation (and not the S-formation).
But with an ACIOL, each haptic is more complex with two supports which are designed to rest in the angle. The key for determining the correct orientation of an ACIOL is to look at the optic-haptic junction, where is should look like the Z-configuration (and not the S-configuration).
Now it is clear that choice “A” is the correct orientation. Also remember that ACIOLs are vaulted so that the central optic is raised above the plane of the haptics. We can look at the ACIOL in profile and determine the correct orientation.