Absorbable, nonabsorbable, and sutureless wound closure in pediatric cataract surgery: systematic review and meta-analysis.

TOPIC: To compare postoperative outcomes of absorbable vs nonabsorbable sutures and sutureless vs sutured incisions in pediatric cataract surgery (0 to 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 used the Mantel-Haenszel fixed-effects model (Review Manager 5.4); certainty of evidence was assessed through Grading of Recommendations Assessment, Development, and Evaluation.

RESULTS

8 studies (4 per comparison) evaluated suture material (321 absorbable and 430 nonabsorbable) and closure technique (1127 sutureless and 187 sutured closure). Absorbable sutures were associated with significantly lower odds of overall complications than nonabsorbable sutures (odds ratio [OR] 2.35; 95% CI 1.38-3.99; P = .002; very low-certainty evidence). Specifically, 10-0 polyglactin 910 outperformed 10-0 nylon (OR 2.18; P = .005; very low-certainty evidence), although loosening was more frequent ( P = .05). Sutureless closure was associated with significantly lower complication odds than sutured techniques (OR 0.34; 95% CI 0.23-0.49; P < .00001; very low-certainty evidence). No significant differences were found for wound leakage ( P = .60) or endophthalmitis ( P = .10).

CONCLUSIONS

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 because sutures are often reserved for leaking wounds. Although nonabsorbable sutures provide early wound security, they seem to increase long-term ocular surface morbidity. Large scale randomized controlled trials are required to establish definitive surgical guidelines.