1482: upside down IOL – who is at fault?

Watch this anonymous video very carefully and let me know who is to blame for this upside down IOL, the surgeon or the scrub tech/assistant? In the photo above you can clearly see that the IOL is in the S configuration and we all know that S means a silly (or stupid) mistake. How did this happen? And what can you do to prevent this in your surgeries? Please give comments below.

link here


  1. Dear dr Devgan, in the first case there is an anterior capsule rupture. Maybe that is the reason why the surgeon is in doubt to flip or not to flip. Do you think flipping the iol in case of an anterior casupsular break the tear can extend to the posterior capsule? I did not hear you mention something about the anterior capsular break.

  2. Correct me if I am wrong, but since the IOL is a single-piece lens, can’t you leave it upside down? It is my understanding that an upside down 3-piece IOL would cause the lens to sit to anteriorly and lead to a myopic outcome (and possibly pupillary block) but a single piece IOL would have no shift. With this being said, I am an advocate for inserting IOLs in the correct orientation and flipping at the time of surgery if inserted upside down. Thanks for your great videos!

    1. the optics are not always symmetric, anterior to posterior. In this case it is the Alcon Vivity EDOF IOL which has a central focusing element on the anterior surface to extended the depth of focus. Putting this element on the posterior aspect (upside down IOL) may affect the optics.

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