This surgical case serves as a critical CataractQuiz™ regarding a common yet preventable postoperative complication: pupil capture. The title picture clearly demonstrates the intraocular lens (IOL) optic protruding anterior to the iris plane. While several factors can lead to this configuration, the underlying etiology in this specific instance is that the three-piece sulcus IOL was implanted upside-down orientation which you can tell from the haptic-optic junction. To prevent this error, surgeons should always remember the 7L rule. When the lens is being inserted correctly, the leading haptic should resemble the number 7 and the trailing haptic should look like letter L. Another easy sign is that if the overall orientation of the haptics looks like the letter S, well then S is for stupid and I do not want to be stupid. In this case, the upside down orientation caused the haptics to vault the optic anteriorly, pushing it into the iris plane. This improper angulation increases the risk of UGH syndrome and chronic inflammation. If you plan on flipping the IOL to the correct orientation inside the eye, keep in mind that you need more than 6 mm from the corneal endothelium to the posterior capsule!
