Efficacy of capsular bag fixation versus ciliary sulcus fixation IOL implantation in children patients: meta-analysis.

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.