Efficacy of capsular bag fixation versus ciliary sulcus fixation IOL implantation in children patients: meta-analysis
In brief
Ciliary sulcus IOL placement more than doubles risk of secondary glaucoma in children
A meta-analysis of eight studies involving 843 pediatric cataract patients found that visual acuity and refractive outcomes were similar whether the intraocular lens was fixed in the capsular bag or the ciliary sulcus. However, sulcus fixation was linked to over twice the chance of developing secondary glaucoma and a higher rate of uveitis, leading authors to favor capsular bag placement with close amblyopia follow-up.
- Journal
- International ophthalmology (Q2)
- Published
- 1 September 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Yilin Wang, Zijie Zhou, Lingdan Wu, Yue Li, Hongfei Liao, Qihua Xu, et al.
- PMID
- 42678450
- DOI
- 10.1007/s10792-026-04244-y
Why clinicians should know about it
- Picked for Ophthalmology (top studies of the week, 6 September 2026): Meta‑analysis of capsular vs sulcus IOL fixation
Abstract
PURPOSE: To systematically compare the safety and efficacy of ciliary sulcus versus capsular bag fixation in pediatric intraocular lens implantation. METHODS: We searched observational studies and RCTs in databases from inception until March 2025. Statistical analysis was performed using RevMan 5.4. RESULTS: Eight studies (843 patients) were included. No significant differences were found in postoperative BCVA, spherical equivalent, visual axis opacity, or inflammation incidence (p > 0.05). Ciliary sulcus fixation showed a significantly higher risk of secondary glaucoma (RR = 0.43, 95%CI 0.20-0.96, p = 0.04). However, this finding was not robust in sensitivity analysis. In acquired cataract cases, myopic shift was more pronounced in the ciliary sulcus fixation group; worse visual outcomes were observed in the capsular bag fixation group among patients without amblyopia therapy. Uveitis incidence was higher in the ciliary sulcus group. CONCLUSION: While both techniques show comparable efficacy, ciliary sulcus fixation significantly increases risks of secondary glaucoma and uveitis, and is associated with myopia progression. Capsular bag fixation is recommended as the preferred approach, with enhanced postoperative amblyopia treatment and long-term monitoring.
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.