As cataract surgery has evolved, intraocular lens (IOL) complications are rare. The purpose of this review is to report incidence, diagnosis, and management of IOL decentrations, Uveitis-Glaucoma-Hyphema (UGH) syndrome, IOL opacifications and refractive surprises. Literature review was performed by searching PubMed, MEDLINE, EMBASE and the Cochrane Controlled Trial Database and reference lists of original studies as well as reviews. IOL decentrations and dislocations can appear at any time particularly in patients with predisposing factors such as pseudoexfoliation, prior vitreoretinal surgery or trauma. Recognizing when they require surgical intervention for UGH or to improve visual function is critical in limiting long-term sequela. IOL opacification such as glistenings rarely require intervention, but others such as SSNGs, calcifications, or discolorations may require IOL exchange. Finally, despite our best efforts to enhance measurements and IOL calculations, refractive surprises still occur. IOL complications are uncommon with modern cataract surgery. A number of these complications require proper identification and care to optimize one’s outcomes.Copyright © 2020. Published by Elsevier Inc.