LASER CAPSULOTOMY IN CHILDREN WITH SECONDARY CATARACTS: INDIVIDUALIZING THE APPROACH BASED ON CLINICAL AND OPHTHALMOLOGICAL DATA

SCIENCE AND INNOVATION IN THE

EDUCATION SYSTEM

International scientific-online conference

126

LASER CAPSULOTOMY IN CHILDREN WITH SECONDARY

CATARACTS: INDIVIDUALIZING THE APPROACH BASED ON

CLINICAL AND OPHTHALMOLOGICAL DATA

Kariyev Abdufarrux Varisovich

Zokirkhuzhaev Rustam Asrolovich

Children's National Medical Center

Doctor of Medical Sciences, Associate Professor Tashkent Medical Academy

https://doi.org/10.5281/zenodo.15280989

Abstract

This study evaluates the effectiveness of an individualized approach to
Nd:YAG laser capsulotomy in pediatric patients with secondary cataracts. A total
of 135 children (270 eyes), aged 8 months to 13 years (mean age: 6.1 ± 2.3
years), were examined after previous cataract surgery. Laser parameters were
selected based on posterior capsule fibrosis density, age, and intraocular lens
(IOL) type. At the 12-month follow-up, 89.6% (242 eyes) retained a clear visual
axis and 83.3% (225 eyes) showed improvement by at least 2 Snellen lines.
Complication rate was reduced to 7.8%. The individualized method enhances
safety and visual outcomes in pediatric laser treatment.

Keywords:

secondary cataract, pediatric ophthalmology, Nd:YAG laser, capsulotomy,
individualized treatment, intraocular lens, laser safety

Relevance

Secondary cataract is one of the most common postoperative complications
following pediatric cataract extraction, particularly in children under 6 years
old. Incidence rates can reach up to 75–85%, and if left untreated, the condition
may lead to irreversible amblyopia. Nd:YAG laser capsulotomy is the primary
treatment, but pediatric patients require specific considerations due to their
ocular anatomy and limited cooperation. Standard laser settings are often
insufficient, increasing the risk of complications such as intraocular pressure
spikes, synechiae, and vitreous prolapse. This highlights the need for a more
tailored approach based on clinical parameters like age, fibrotic density, and IOL
type. Implementing an individualized strategy could improve visual
rehabilitation and reduce adverse outcomes. This study addresses the gap in
standardized pediatric laser protocols and provides evidence for adjusting laser
settings according to specific patient characteristics, offering an important step
toward optimized pediatric ophthalmic care.

Aim:

To develop and clinically validate an individualized protocol for Nd:YAG

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laser capsulotomy in children with secondary cataracts based on clinical and
ophthalmological factors.

Materials and Methods

The study included 135 children (270 eyes) aged between 8 months and 13

years, with prior surgery for congenital or acquired cataract. Preoperative
evaluation included slit-lamp biomicroscopy, posterior segment OCT, and
indirect ophthalmoscopy to assess posterior capsule opacification. Laser settings
(energy, pulse count, opening diameter) were individualized. General anesthesia
or IV sedation was used in 32 children under 4 years. Patients were followed up
at 1, 3, 6, and 12 months. Outcomes measured were visual acuity, visual axis
clarity, intraocular pressure, and complications. Data were analyzed using
Student’s t-test and χ² test, with significance at p<0.05.

Results

At 12-month follow-up, 89.6% (242 eyes) demonstrated a clear optical axis,
and 83.3% (225 eyes) had a visual acuity gain of ≥2 Snellen lines. Complications
occurred in 7.8% (21 eyes): elevated intraocular pressure in 4.8% (13 eyes),
anterior uveitis in 2.2% (6 eyes), and posterior synechiae in 0.7% (2 eyes).
Repeat laser treatment was required in 9.6% of cases, primarily among children
under 3 years. Compared to a historical control group treated with fixed
parameters, complication rates were 1.7 times lower (p<0.01), and visual
improvements were significantly better (p<0.05), supporting the effectiveness of
individualized capsulotomy protocols

Conclusion

An individualized Nd:YAG laser approach significantly improves outcomes
in pediatric patients with secondary cataracts. Adjusting laser parameters based
on patient age, fibrosis density, and IOL type results in clearer visual axes, better
visual acuity, and fewer complications. The success rate of maintaining optical
clarity (89.6%) and visual improvement (83.3%) confirms the clinical value of
personalization. The protocol also demonstrated a lower need for retreatment
and minimized intraoperative risks. These findings support the adoption of
tailored strategies in routine pediatric ophthalmic practice and suggest the
potential for standardizing individualized algorithms to improve long-term
visual rehabilitation in children after cataract surgery.

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