Purpose To report the rate and management of intra‐ and early postoperative complications of bag‐in‐the‐lens intraocular lens (IOL) implantation technique for cataract treatment in paediatric patients of different age groups. Settings Department of Ophthalmology, Justus‐Liebig‐University Giessen, University Hospital Giessen and Marburg GmbH, Campus Giessen, Giessen, Germany. Design Retrospective non‐randomized consecutive case series. Methods Ninety eyes of 60 paediatric cataract patients were enrolled to this retrospective non‐randomized observational consecutive case series single‐centre study. All patients underwent cataract surgery with bag‐in‐the‐lens IOL implantation between January 2008 and December 2018, performed by two experienced surgeons. The entire cohort was divided into four age groups: first – 0–<3 months, second – 3–<12 months, third – 12–<36 and fourth – >36 months–17 years of age. The intra‐ and postoperative complications were based on the clinical records. The description of management of complications related specifically to bag‐in‐the‐lens IOL technique was based on the 39 consecutive cases operated since 1 Jan 2016 by one single surgeon that were all video documented. The early postoperative period was defined as 12 months after surgery. Results Overall, there were 27 unilateral and 33 bilateral surgical cases of 24 female and 36 male children. The mean age at surgery was 45.25 months (range 1–200 months). The most common intraoperative events were vitreous prolapse and anterior capsule rupture with 28.9% and 13.3%, respectively. Within 12 months of follow‐up, five eyes (5.6%) were re‐operated because of visual axis reo‐pacification (VAR). Intraocular hypertension was diagnosed in seven eyes (7.8%), including two cases that required surgical treatment. In all cases with intra‐ and early postoperative complications related specifically to bag‐in‐the‐lens technique, it was possible to manage them and successfully implant bag‐in‐the‐lens IOL. Conclusions Implementation of bag‐in‐the‐lens technique in the treatment of paediatric cataract was associated with a relatively low rate of intra‐ and postoperative complications, including rare cases of VAR. The correct management of complications related specifically to bag‐in‐the‐lens IOL implantation technique shall to be considered during the learning curve.

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