• IOL flip
• foldable lens implantation

Phacoemulsification surgery offers many advantages in comparison with extracapsular cataract extraction (ECCE). In particular, faster visual rehabilitation and better control over surgically induced astigmatism are well established benefits over ECCE.^1,2 These advantages are largely due to the small size of the cataract incision.³

Inadvertent insertion of a posterior chamber intraocular lens (IOL) with a reversed front to back orientation is a surgical dilemma that will present occasionally. Anecdotal evidence suggests that while this problem is not common, it is not a rare event. Reported data place the frequency between 1.0–1.3%.^4–6

Often, IOL inversion is only recognised after the optic has unfolded within the eye. The small phacoemulsification wound, while acting as an ally in the postoperative recovery of the patient, has in this situation become a foe to the surgeon. Faced with this situation, the surgeon has a few options. The simplest would be to leave the IOL inverted. Indeed, this has been advocated by some authors.⁴ The second would be lens explantation and exchange. However, this often involves sacrificing the IOL⁷ and is difficult to perform. Alternatively, enlarging the cataract incision to the size of the optic would allow extraction and reinsertion without damage to the IOL. Unfortunately, this would diminish the benefits inherent …