title: Upside-down lens syndrome: ocular complications secondary to inverted implantation of the Kelman Multiflex anterior chamber intraocular lens.
abstract: OBJECTIVE
  To describe ocular complications resulting from inverted insertion of a Kelman Multiflex anterior chamber intraocular lens (ACIOL).
  
  
  METHODS
  Retrospective observational case series.
  
  
  METHODS
  We describe the outcomes of 4 cases of complicated cataract surgery in which a flexible open-loop polymethylmethacrylate (PMMA) ACIOL (Kelman Multiflex type) was placed in an inverted configuration, all of which were referred to a single institution.
  
  
  RESULTS
  In all 4 cases, the placement of an inverted ACIOL resulted in ocular complications including chronic iritis, cystoid macular edema, pupil capture, iris adhesions, and corneal decompensation.
  
  
  CONCLUSIONS
  Inadvertent inverted placement of the Kelman Multiflex anterior chamber intraocular lenses can lead to a constellation of severe ocular complications. When inserting such lenses, the surgeon should ensure that the lens is correctly oriented such that the optic vaults anteriorly and not posteriorly.
authors.affiliation: Cornea Service, Department of Ophthalmology, University of California San Francisco, San Francisco, California 94143-0730, USA.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Fintelmann
authors.forename: Shane K
authors.initials: SK
authors.lastname: Kim
authors.forename: David G
authors.initials: DG
authors.lastname: Hwang
mesh_terms: D000368:Aged; D000867:Anterior Chamber / Q000601:surgery*; D002386:Cataract / Q000150:complications; D005260:Female; D006801:Humans; D007500:Iritis / Q000209:etiology; D019654:Lens Implantation, Intraocular / Q000009:adverse effects* / Q000379:methods; D007910:Lenses, Intraocular; D008269:Macular Edema / Q000209:etiology; D008297:Male; D019300:Medical Errors / Q000009:adverse effects*; D019904:Polymethyl Methacrylate; D011183:Postoperative Complications; D012189:Retrospective Studies
chemical_list: D019904:Polymethyl Methacrylate