Long-Term Safety and Visual Outcomes of Capsular laser Laser- Assisted Anterior Capsulotomy in Pediatric Cataract Surgery: A Multicenter Retrospective Case Series

Abstract Purpose To evaluate the long-term safety, intraoperative outcomes, and visual results of capsular laser-assisted anterior capsulotomy in pediatric cataract surgery, addressing the technical challenges of capsulorrhexis in the elastic pediatric lens capsule. Methods This multicenter retrospective case series included 26 eyes of 18 consecutive pediatric patients (mean age 3.22 ± 3.93 years, range 2 months to 13 years) who underwent cataract surgery with capsular laser-assisted cataract surgery (CLACS) anterior capsulotomy using the EXCEL-LENS system between 2023–2024. All patients received intraocular lens implantation. Primary outcomes included intraoperative capsulotomy success rate, capsular tear incidence, and postoperative complications. Secondary outcomes included best-corrected visual acuity (BCVA) stratified by age (< 12 months vs ≥ 12 months) and laterality (unilateral vs bilateral). Statistical analysis was performed using appropriate parametric and non- parametric tests. Results Successful well-centered anterior capsulotomy was achieved in 24/26 eyes (92.3%). Anterior capsular tears occurred in 2 eyes (7.7%) but did not extend posteriorly, allowing safe intraocular lens placement in all cases. Posterior capsular opacification (PCO) developed in 13/26 eyes (50%) at a mean of 6.47 ± 1.2 months postoperatively, all requiring Nd: YAG laser capsulotomy. Visual outcomes of ≥ 20/40 were achieved in 60% of unilateral cases and 37% of bilateral cases. Age- stratified analysis showed superior outcomes in patients ≥ 12 months at surgery. Mean follow-up was 8.96 ± 12.29 months. No cases of intraocular lens decentration, tilt, or other serious complications occurred. Conclusions Capsular laser-assisted anterior capsulotomy in pediatric cataract surgery demonstrates excellent safety with high success rates and predictable visual outcomes. The technique offers significant advantages over manual capsulorrhexis in the challenging pediatric population, with low complication rates and favorable long-term visual results. However, the high incidence of PCO necessitates close postoperative monitoring and potential secondary interventions.