Reversal of fortune: Managing a flipped intraocular lens-induced glaucoma crisis

We report a case of secondary angle-closure glaucoma due to a flipped intraocular lens (IOL) following posterior capsular rupture (PCR) during phacoemulsification. A 39-year-old female presented with acute pain, diminished visual acuity, and elevated intraocular pressure (IOP) 5 days after cataract surgery. Slit-lamp examination revealed a shallow anterior chamber (AC), corneal edema, and a flipped multi-piece IOL with 360° optic capture. Nd: YAG peripheral iridotomy failed to reduce IOP, necessitating IOL repositioning. The IOL was correctly oriented and repositioned into the sulcus. Postoperatively, the AC was restored to normal depth, and the IOP had normalized. This case underscores the importance of proper IOL orientation during implantation and recognizing its improper orientation as an etiology for secondary glaucoma and emphasizes the need for prompt surgical intervention.