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A 74-year-old woman underwent bilateral cataract surgery with in-the-bag placement of Crystalens HD IOLs (Bausch + Lomb, Rochester, NY). The patient complained of worsening vision and the six months postoperative examination found a clear posterior capsule but bulging of the inferior iris secondary to IOL touch in her right eye. Imaging demonstrated significant tilting of the IOL in the patient’s right eye consistent with the entity known as Z syndrome. Dr. Cionni exchanged the lens for a single-piece hydrophobic acrylic IOL.

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