Absorbable, Non-absorbable, and Sutureless Wound Closure in Pediatric Cataract Surgery: A Systematic Review and Meta-Analysis
In brief
Sutureless pediatric cataract incisions cut complications by two thirds
A meta-analysis of eight studies found that sutureless wound closure in children reduced overall postoperative complications to roughly one third of the rate seen with sutured techniques, while absorbable sutures also lowered complications compared with non-absorbable material. Evidence is very low certainty, so larger trials are needed before practice changes.
- Journal
- Journal of cataract and refractive surgery (Q1)
- Published
- 22 July 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Yuri Aleksander-Ivanov, Carolina C S Valentim, Davi M Veiga, Pedro L M Magalhães, Luiz Alberto Zago Filho, Mehmet E Guner, et al.
- PMID
- 42507531
- DOI
- 10.1097/j.jcrs.0000000000002018
Why clinicians should know about it
- Picked for Ophthalmology (top studies of the week, 2 August 2026): Absorbable sutures reduce postoperative complications
Abstract
TOPIC: To compare postoperative outcomes of absorbable versus non-absorbable sutures and sutureless versus sutured incisions in pediatric cataract surgery (0-18 years). CLINICAL RELEVANCE: 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. METHODS: 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). RESULTS: 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). CONCLUSION: 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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.