Capsulotomy With Supine Nd:YAG Laser in Children

OBJECTIVES: To evaluate the visual outcomes of Nd:YAG laser posterior capsulotomy performed in the supine position under general anesthesia in children with visual axis opacification after cataract surgery. MATERIALS AND METHODS: A retrospective clinical case series of 13 eyes of 9 children with visual axis opacification following congenital, uveitic, or juvenile cataract surgery was conducted. All patients underwent Nd:YAG laser posterior capsulotomy in the supine position under general anesthesia at the Eye Clinic, University Medical Centre Ljubljana, between September 2019 and November 2025. RESULTS: Posterior capsulotomy was successfully performed in all 13 eyes. The median age at treatment was 9.1 years (range: 0.9-14 years) and the median follow-up was 23.8 months (range: 2-60 months). Mean best corrected visual acuity (BCVA) improved from 0.85 ± 0.60 logMAR preoperatively to 0.64 ± 0.73 logMAR postoperatively (p = 0.002). Three eyes (23%) required a secondary Nd:YAG capsulotomy due to recurrent VAO. Transient intraocular pressure elevation occurred in two eyes (15%) and resolved with topical treatment. No other complications were observed. CONCLUSIONS: This study demonstrates the feasibility of performing Nd:YAG laser posterior capsulotomy under general anesthesia to manage VAO in children who are unable to undergo the procedure in the standard seated position.