The management of posterior capsular rupture entails additional decisions about fixation and stability of the intended IOL. This is particularly important with refractive IOLs, such as toric and multifocal implants. Balanced against the patient’s disappointment at not receiving their preferred IOL is the fact that these refractive IOL platforms are much less forgiving of tilt, decentration, misalignment, and residual refractive error. Following posterior capsular rupture, the options for IOL fixation will depend on the size and location of the capsular or zonular defect and the type of IOL contemplated.