Reopening the capsular bag by removing the capsular proliferative membrane to enable secondary in-the-bag IOL implantation in pediatric aphakic eyes

To present a surgical technique for reopening the capsular bag in pediatric aphakia.Zhongshan Ophthalmic Center, Guangzhou, China.Case series study.Consecutive pediatric bilateral aphakic patients requiring secondary intraocular lens (IOL) implantation between July 2021 and June 2022 were included. The diameter of the capsular proliferative membranous ring (PMR) and position of IOL implantation were documented. Various parameters of capsular opening during primary cataract removal and secondary surgery were also analyzed.Forty-eight eyes were included with a mean follow-up of 8.1±4.4 months. Using surgical technique developed here, the capsular bag was successfully reopened with in-the-bag (ITB) implantation in 43 eyes (89.6%). ITB implantation was accomplished in all eyes with an outer diameter of PMR≤5.5 mm, and in 3 of 8 eyes (37.5%) with an outer diameter of PMR>5.5 mm. A positive correlation was observed between the primary and secondary anterior capsular opening diameters (ACOD) (r=0.422, P=0.007) and the primary and secondary posterior capsular opening diameters (PCOD) (r=0.619, P<0.001). The inner diameter of PMR was found to be positively correlated with secondary PCOD (r=0.728, P<0.001), and the outer diameter with secondary ACOD (r=0.669, P<0.001).This is a safe and effective surgical technique for pediatric secondary IOL implantation with maximum preservation of the peripheral capsule. Aphakic eyes with an outer diameter of PMR≤5.5 mm are preferred for secondary ITB implantation.