An upside-down intraocular lens is a rare but serious intraoperative complication that requires prompt recognition and decisive management. When an attempt is made to flip a single-piece IOL within the capsular bag, excessive torque or posterior pressure can transmit force directly to the posterior capsule, resulting in a capsular break. Once a posterior capsule rupture has occurred, further manipulation within the bag risks enlarging the defect, even in the absence of vitreous prolapse. In this setting, the safest approach may be to explant the malpositioned lens rather than attempt further rotation. The capsular bag should be stabilized with cohesive viscoelastic, and the damaged single-piece IOL carefully removed through an enlarged incision. A three-piece IOL is then placed in the ciliary sulcus, as its thin haptics are specifically designed for sulcus fixation and provide better long-term stability. Even without vitreous loss, abandoning in-the-bag placement reduces the risk of late decentration, uveitis–glaucoma–hyphema syndrome, and secondary visual complications. What would you have done? Comment below. Thanks
