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A 76-year-old male underwent a complex cataract surgery, which ended up with an ACIOL implantation. Since the surgery, he has experienced elevated IOP, leading to the decision to exchange the IOL. During the procedure, the ACIOL was removed through a scleral tunnel. Due to corneal astigmatism, a toric IOL with four closed-loop haptics was fixated to the sclera using the four-flanged technique.
