Rarely, IOLs will opacify with time with some designs more prone to this than others. In these cases we need to explant the opacified IOL and replace it with a new IOL. But this can be challenging, particularly if the IOL is adherent to the capsular bag and if the patient has already undergone YAG laser capsulotomy treatment. In this case, the IOL is removed from the capsular adhesions but this causes loss of potential capsular support thereby preventing even a sulcus IOL placement. The surgeon chooses to perform a Yamane fixation instead. The key in these cases is spending enough time gently dissecting the IOL from the capsular bag to preserve as much tissue support as possible. Tough case indeed!