Looking at this title pic, you can see a large degree of capsular phimosis. This progressive constriction of the capsulorhexis pulls on the zonular attachments and weakens them over time. At this stage, there is virtually no zonular support and the IOL and capsular bag complex is very mobile and dislocated. The surgeon here decides to remove the existing IOL and capsular bag and then implant an ACIOL. While the newer techniques of scleral fixation of a posterior chamber IOL, such as the Yamane technique, are becoming more popular, the ACIOL has a long and stable track record. Studies have shown that a properly oriented and sized ACIOL will perform as well as a scleral fixated PCIOL. You must also know how to calculate the power of the ACIOL because the optic position is more anterior than a PCIOL. While this surgery is very good, I would make a different incision: I much prefer a scleral tunnel over a corneal incision when it must be 6 mm in width. What are your thoughts on ACIOLs?