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  • Cataract/Anterior Segment, Pediatric Ophth/Strabismus

    Investigators in China tested a surgical technique to help simplify in-the-bag IOL implantation for patients with pediatric aphakia.

    Study Design

    A prospective case series study, conducted as part of the Chinese Ministry of Health’s Childhood Cataract Program, included 48 consecutive pediatric patients who required secondary IOL implantation after primary cataract extraction left them with bilateral aphakia. All patients underwent a surgical technique that involved continuously reopening the capsular bag for secondary in-the-bag IOL implantation. A space was created between the capsular proliferative membrane ring (PMR) and the capsulorrhexis, using a cystotome to hook the outer edge of the membrane. The PMR was then peeled off using a curvilinear capsulorrhexis technique, leaving clear views of the anterior and posterior capsulorrhexis openings without the need for cutting or blunt dissection of the remaining capsule.


    The capsular bag was successfully reopened in all cases, with in-the-bag implantation occurring in 90% of eyes and sulcus implantation occurring in the remaining 10%. Secondary anterior capsular opening diameter (ACOD) and posterior capsular opening diameter (PCOD) correlated positively with primary ACOD and PCOD, respectively.


    Limitations of this study included its observational nature and small case population. As well, follow-up periods were relatively short (mean 8.1 months).

    Clinical Significance

    This surgical technique to reopen the capsular bag in pediatric aphakia has the potential to improve the chances of in-the-bag implantation of a lens, as it focuses on removal of the PMR. However, it was challenging to understand the technique without having a corresponding video available on the journal website.

    Financial Disclosures: Dr. Sara Bozorg discloses no financial relationships.