3054: Quiz: What is wrong with this sulcus IOL?

Look carefully at this picture. In particular the orientation of the haptic-optic junction. Spotting an inverted three-piece IOL in the ciliary sulcus requires a sharp diagnostic eye, and this case highlights how critical optic-haptic junction geometry is for intra-ocular stability. When a three-piece lens is inserted upside down, the built-in haptic-optic angulation reverses its effect, vaulting the central optic anteriorly toward the iris rather than posteriorly away from it. This anterior displacement leads directly to recurrent iris capture, pigment dispersion, and potential uveitis-glaucoma-hyphema (UGH) syndrome. The definitive intra-operative solution involves carefully flipping the IOL into its correct orientation so the haptics vault the optic posteriorly away from the iris, followed by capturing the optic through the anterior capsulorhexis margin. Securing optic capture behind the rhexis provides exceptional long-term centration, locks in the effective lens position, and permanently prevents future anterior displacement. Watch the video to see the surgical technique for flipping and capturing an inverted sulcus IOL. How do you routinely verify correct haptic orientation (“7L” configuration) before delivering a three-piece IOL into the sulcus? Please comment your thoughts below.

video link here