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Visual axis opacification (VAO) is a recognised complication of paediatric cataract surgery. This study aimed to evaluate VAO intervention rates and the effect of primary posterior capsulotomy (PPC) in children under 8 undergoing primary intraocular lens (IOL) implantation at Leeds Teaching Hospitals NHS Trust (2014–2024).We retrospectively reviewed 40 eyes from 30 patients (10 bilateral, 20 unilateral). Patients were grouped by age: <2 years (12 eyes), 2–5 years (20 eyes), and 6–8 years (8 eyes). Data collected included PPC status, intervention type, time to intervention, and complications.PPC was performed in 8/12 eyes (67%) in the <2 group, 9/20 eyes (45%) in the 2–5 group, and none in the 6–8 group.VAO intervention occurred in: 3/8 (38%) with PPC vs 3/4 (75%) without PPC in <2s. 3/9 (33%) with PPC vs 8/11 (73%) without PPC in 2–5s. 2/8 (25%) in 6–8s (no PPC)Intervention was surgical in 14 eyes (35%) and via YAG in 5 (13%). Median time to intervention increased with age: 7 months (<2), 15 months (2–5), 58 months (6–8). One patient developed glaucoma; two eyes required repeat procedures; no retinal detachments occurred.This reinforces previous studies showing PPC reduces VAO in children under 5. Children aged 6–8 had a lower rate of VAO and longer time to onset, even without PPC.These findings support the continued use of PPC in children under 5 and suggest a reduced need for intervention in older children.