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Absorbable, nonabsorbable, and sutureless wound closure in pediatric cataract surgery: systematic review and
Yuri Aleksander-Ivanov1, Carolina C S Valentim, Davi M Veiga
1From the School of Medicine, University of Southern Santa Catarina (UNESC), Criciuma, Brazil (Aleksander-Ivanov); Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, Kentucky (Valentim, Guner); Marilia Medical School (FAMEMA), Marilia, Brazil (Veiga); School of Medicine, Institute of Medical Education, Angra dos Reis, Brazil (Magalhães); Department of Ophthalmology and Otorhinolaryngology, Federal University of Parana, Curitiba, Brazil (Filho); Oftalmolages Eye Hospital, Lages, Brazil (Filho); Norton Children's Hospital, Louisville, Kentucky (Guner); Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina (Wilson).
Insights
Absorbable sutures and sutureless wound closure techniques in pediatric cataract surgery significantly reduce overall complications compared to non-absorbable sutures and sutured incisions. Further research is needed to confirm these findings.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Surgical Techniques
Background:
- Pediatric cataract surgery necessitates meticulous wound closure for optimal postoperative stability.
- The choice of suture material and closure technique impacts complication rates and the need for reoperation.
Purpose of the Study:
- To compare the postoperative outcomes of absorbable versus non-absorbable sutures in pediatric cataract surgery.
- To evaluate sutureless versus sutured incisions in pediatric cataract surgery.
Main Methods:
- Systematic review and meta-analysis of eight studies comparing suture materials and closure techniques.
- Searches conducted in PubMed, Embase, Cochrane, and Web of Science.
- Primary outcome: overall rate of postoperative complications; certainty of evidence assessed using GRADE.
Main Results:
- Absorbable sutures were linked to lower overall complication rates than non-absorbable sutures (OR 2.35).
- Sutureless closure showed significantly lower complication odds compared to sutured techniques (OR 0.34).
- No significant differences observed in wound leakage or endophthalmitis rates.
Conclusions:
- Absorbable sutures and sutureless techniques appear to reduce overall complications in pediatric cataract surgery.
- Evidence is limited by very low certainty and potential bias; non-absorbable sutures may increase long-term morbidity.
- Large-scale randomized controlled trials are required to establish definitive surgical guidelines.
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.
