You may be surprised to learn that an upside down IOL happens to every single cataract surgeon. The key is to recognize it as it happens and then to recover by flipping and re-orienting the IOL. What if the haptic is also bent? Look at the pic above and tell me what you would do in this case. Explant the IOL? What if there is no back-up lens for this unusual IOL power? Leave the patient aphakic? Leave the damaged and decentered IOL in the eye? Click below to see how I solved this case and for a great review of the 7L rule.