3027: try to flip the IOL but the capsule breaks
Injecting an inverted intraocular lens into the capsular bag creates a treacherous situation: attempting to flip a fully unfolded upside-down IOL in a tight space places excessive stress on the delicate capsular tissue, turning a simple orientation error into a posterior capsule rupture. This challenging case highlights why surgeons must always keep the 7L rule top of mind during delivery—ensuring the leading haptic points like a number 7 and the trailing haptic forms an L as the lens exits the cartridge. When an upside-down delivery occurs, prolapsing the lens into the anterior chamber with generous viscoelastic before attempting to flip or exchange it is far safer than manipulating it inside the bag. Watch the video to see how this intraoperative attempt to rotate the inverted optic leads to a capsular break and how the surgeon recovers the case. If an IOL is delivered inverted, do you prefer flipping it in the anterior chamber, or do you immediately refold/cut and exchange it? Please comment your thoughts below.
