ESCRS - POCAT239 - To Bil Or Not To Bil? Overcoming Challenges In Using Bag-In-The-Lens Implant And Conversion To 3-Piece Iol Optic Capture As An Alternative Technique

To Bil Or Not To Bil? Overcoming Challenges In Using Bag-In-The-Lens Implant And Conversion To 3-Piece Iol Optic Capture As An Alternative Technique

Published 2026 - 44th Congress of the ESCRS

Reference: POCAT239 | Type: Free paper | DOI: 10.82333/bznm-dy42

Authors: Dr Cătălina Ioana Tătaru 1 , Prof. Dr Călin Petru Tătaru* 2 , Dr Cristina Cojan 3 , Dr Maria Cristina Halici 3 , Dr Dinu Bogdan Tiutiucă 3 , Dr Emanuela Băcăoanu 3 , Dr Paul Filip Curcă 4

1Ophthalmology,Clinical Institute for Ophthalmological Emergencies “Prof. Dr. Mircea Olteanu”, Carol Davila University of Medicine and Pharmacy Bucharest,Bucharest,Romania;Ophthalmology Compartment I,Clinical Institute for Ophthalmological Emergencies “Prof. Dr. Mircea Olteanu”,Bucharest,Romania;Alcor Clinic,Bucharest,Romania, 2Ophthalmology,Central Military Emergency Hospital Dr. Carol Davila, Carol Davila University of Medicine and Pharmacy,Bucharest,Romania;Ophthalmology Compartment I,Clinical Institute for Ophthalmological Emergencies “Prof. Dr. Mircea Olteanu”,Bucharest,Romania;Alcor Clinic,Bucharest,Romania, 3Ophthalmology Compartment I,Clinical Institute for Ophthalmological Emergencies “Prof. Dr. Mircea Olteanu”,Bucharest,Romania, 4Ophthalmology,Central Military Emergency Hospital Dr. Carol Davila, Carol Davila University of Medicine and Pharmacy,Bucharest,Romania

Purpose

Bag-in-the-Lens implants are advantageous in pediatric patients in providing a lasting clear visual axis. However, use can be technically difficult in small pupils, in the presence of pupillary membrane and unresponsive pupil dilation.

Setting

Retrospective surgical case series detailing challenging BIL cases and conversion technique to 3-piece IOL posterior capture.

Methods

Retrospective surgical case series:

First case: congenital cataract is accompanied by a pupillary membrane. Technique: spatula + vitreous cutter synechiolysis, use of iris hooks for pupillary dilation, BIL implant.

Second case: congenital cataract is accompanied by anterior synechiae. Technique: vitreous cutter synechiolysis, pupil sculpting with vitreous cutter, BIL implant.

Third case: congenital posterior polar cataract. Technique: traditional BIL technique capsulorhexis, lens mass aspiration, use of viscoeleastic surgical device to expand Berger space, posterior rhexis, BIL implant.

Fourth case: Congenital cataract. Difficult capsulorhexis, weak zonular support. Technique: conversion to 3-piece IOL with posterior optic capture.

Results

First case: synechiolysis using firstly the spatula and secondly the vitreous cutter to excise remaining adherences. Afterwards 4 hooks were placed to obtain a sufficient pupil size for capsulorhexis. Using a guide ring capsulorhexis was performed, followed by lens mass aspirations and posterior capsulorhexis. A BIL implant was implanted with good visual results.

Second case: used the vitreous cutter to resolve adherences and finally placed a BIL implant.

Third case: Traditional BIL technique, BIL implant with good visual results.

Fourth case: 7-year old male patient, BIL not feasible due to difficult capsulorhexis, weak zonular support. Conversion to 3-piece IOL with posterior optic capture.    

Conclusions

Bag-in-the-Lens implants are preferable in paediatric patients and are possible even in the case of small pupils, pupillary membranes or anterior synechiae so long as an appropriate capsulorhexis and posterior rhexis are achieved. In case of technical difficulties we recommend conversion to 3-piece IOL optic capture, with the optic captured behind the two rhexis to coalesce the two capsules, preventing secondary cataract formation.