Lateral Decubitus Position for Pediatric Nd:YAG Laser Capsulotomy under General Anesthesia

Abstract

Purpose: To report a successful case of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy performed in a noncompliant pediatric patient using the lateral decubitus position and a conventional slit-lamp-based laser system under general anesthesia.Case summary: Progression of a thick posterior capsular opacity with associated vision loss (best-correct visual acuity of 0.1) was detected in a nine-year-old child with a past history of cataract surgery in his right eye. Diagnosed with pediatric uveitis at the age of five, he had been treated previously using a combination of topical and systemic corticosteroids, which led to the development of the cataract and subsequent surgery 16 months later. Severe photophobia prevented outpatient-based laser treatment, and the patient underwent our modified procedure. Under general anesthesia, the patient was placed in a lateral decubitus position with the use of a long intubation tube. The height of the bed and table-based laser system was adjusted so as to minimize strain when positioning the child’s head. Successful laser capsulotomy was performed within 10 minutes, and the entire anesthesia time was less than 30 minutes. The patient experienced immediate improvement in symptoms, showing a visual acuity of 1.0, which has been sustained as of his most recent visit, 3 months postoperatively. The patient experienced no ocular or anesthesia- related complications. Conclusions: Nd:YAG laser capsulotomy performed by careful positioning (lateral decubitus) under general anesthesia is a viable strategy for the safe and efficient removal of posterior capsular opacities in children with poor compliance.