Thirty-two eyes of 28 pediatric patients were treated with the H. S. Meridian Microruptor III Nd:YAG laser for secondary posterior capsular membranes after cataract extraction either with or without posterior chamber intraocular lens implantation. This laser allows for 90-degree rotation of the laser delivery system to treat recumbent patients who may be under general endotracheal anesthesia. In all patients, at least a 5-mm axial capsulotomy was created. The energy requirements for the procedure were related to the density of the membrane, which correlated with the time lapse between cataract extraction and laser capsulotomy. A second laser capsulotomy was performed in eight eyes. Nd:YAG capsulotomy can be performed in a child of any age by using the Microruptor III. For surgeons who choose to retain the posterior capsule in pediatric cataract extraction, particularly after posterior chamber intraocular lens implantation, this technique offers the noninvasive capability to create and maintain a clear visual axis.