Absorbable, Non-absorbable, and Sutureless Wound Closure in Pediatric Cataract Surgery: A Systematic Review and Meta-Analysis.

Authors

Yuri Aleksander-Ivanov, Carolina C S Valentim, Davi M Veiga, Pedro L M Magalhães, Luiz Alberto Zago Filho, Mehmet E Guner, M Edward Wilson

Published in

Journal of cataract and refractive surgery. Jul 22, 2026. Epub Jul 22, 2026.

Abstract

To compare postoperative outcomes of absorbable versus non-absorbable sutures and sutureless versus sutured incisions in pediatric cataract surgery (0-18 years).
Pediatric cataract surgery requires precise wound closure to ensure postoperative stability. Identifying the most effective closure method is essential to minimize complications and the need for reintervention under general anesthesia.
The review protocol was registered in the International Prospective Register of Systematic Reviews (CRD420251174549). We searched PubMed, Embase, Cochrane, and Web of Science (inception to October 2025). The primary outcome was the overall rate of postoperative complications. Meta analysis utilized Mantel-Haenszel fixed-effects model (Review Manager 5.4); certainty of evidence was assessed via Grading of Recommendations Assessment, Development and Evaluation (GRADE).
Eight studies (four per comparison) evaluated suture material (321 absorbable; 430 non-absorbable) and closure technique (1,127 sutureless; 187 sutured closure). Absorbable sutures were associated with significantly lower odds of overall complications than non-absorbable sutures (OR 2.35; 95% CI 1.38 to 3.99; P=0.002; very low-certainty evidence). Specifically, 10-0 polyglactin 910 outperformed 10-0 nylon (OR 2.18; P=0.005; very low-certainty evidence), though loosening was more frequent (P=0.05). Sutureless closure was associated with significantly lower complication odds than sutured techniques (OR 0.34; 95% CI 0.23 to 0.49; P<0.00001; very low-certainty evidence). No significant differences were found for wound leakage (P=0.60) or endophthalmitis (P=0.10).
Absorbable sutures and sutureless techniques are associated with a lower risk of overall complications. However, results are limited by very low-certainty and potential selection bias, as sutures are often reserved for leaking wounds. While non-absorbable sutures provide early wound security, they appear to increase long term ocular surface morbidity. Large scale RCTs are required to establish definitive surgical guidelines.

PMID:
42507531
Bibliographic data and abstract were imported from PubMed on 28 Jul 2026.

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