Background: Correct orientation of a foldable intraocular lens (IOL) is crucial for achieving desired postoperative refractive outcomes. A reversed IOL, although rare, can occur even in experienced hands and is more likely during residency training. This situation is particularly significant when premium or high-power IOLs are implanted. In such cases, even minor changes in effective lens position can compromise visual quality. The correct intraoperative IOL orientation appears as an “inverse S” configuration of the haptics under the microscope, and clues such as an “S”-shaped haptic pattern or spontaneous optic vaulting after unfolding should raise suspicion of reversed implantation. While observation is an option in most cases, significant dioptric shifts, premium IOL use, or improper vaulting often necessitate correction. Purpose: This instructional video demonstrates the IOL flip technique — a safe, efficient, and minimally traumatic intraocular manoeuvre that corrects reversed foldable IOL orientation without the need for explantation. Synopsis: The IOL flip technique involves filling the anterior chamber and capsular bag with cohesive viscoelastic, followed by the use of two blunt instruments (commonly two Sinskey hooks) placed anteriorly and posteriorly around the optic edge to perform a controlled 180° rotation in a clockwise or anticlockwise direction, akin to flipping a coin. Typical indications include reversed implantation of foldable posterior chamber IOLs in an intact capsular bag with stable zonules. The technique is not recommended in eyes with capsular compromise, zonular weakness, or rigid IOLs. Highlights: This video presents multiple cases of reversed IOL implantation and guides the viewer through a step-by-step demonstration of the IOL flip technique. It is particularly valuable for residents and early-career surgeons.
Rajasekar et al. (Wed,) studied this question.