Objective To observe the clinical results of Akreos adaptable foldable intraocular lens (IOL) implantation when the posterior capsule has a large rupture. Methods Thirty-one cataract cases (31 eyes) with a large rupture in the posterior capsule underwent Akreos adaptable foldable IOL implantation with crossed bag/sulcus fixation. Of these, 9 had traumatic cataracts and 22 had age-related cataracts. A continuous curvilinear capsulorhexis (CCC) technique was used and the diameters were about 5.0-5.5 mm. When the posterior capsule rupture was found during the operation, after the cortex or vitreous loss was cleanly managed with a vitreous cutter, the IOL was first implanted into the anterior chamber, the two haptics from the opposite angles were then pressed into the capsular bag. The remaining haptics were left on the surface of the anterior capsule. Thus,the IOL was implanted with crossed bag/sulcus fixation. Visual acuity, visual symptoms, the position and fixation of the IOL, inflammatory reaction and posterior capsule opacity were assessed postoperatively. All cases were followed up for at least 3 months. Results The visual acuity of all surgical eyes was improved after the operation. The best corrected visual acuity was 0.1-0.2 in 4eyes, 0.3-0.4 in 5 eyes, and ≥0.5 in 22 eyes. The implanted IOL remained centered and stable in all surgical eyes and no displacement was observed. The optics of the IOL and the posterior capsule holes were clear without fibroplasias. The pupils were centered and no posterior synechia, severe inflammation, IOL-related complications or glare occurred. Conclusion While a posterior capsule with a large rupture appeared, good CCC is still possible during the operation. The use of crossed bag/sulcus fixation to implant the Akreos adaptable foldable IOL is easy and safe. The IOL position is centered and no displacement occurred after the implantation. The results show good biocompatibility and stability with low postoperative inflammation and low posterior capsule opacity (PCO) due to it