Meta-Analysis of the Clinical Efficacy of Intraocular Lens (IOL) Implantation Surgery for Pediatric Cataracts

Author: Zheng L, Ni S, Zhang J, Fu Y, Xu G, Zhao S, Zhao J.

Geographical coverage: China, Iran, Austria, India

Sector: Service delivery

Sub-sector: Surgical interventions

Equity focus: Not reported

Study population: Children (≤14 years) with cataracts

Review type: Effectiveness review

Quantitative synthesis method: Meta-analaysis

Qualitative synthesis method: Not applicable

Background:

Paediatric cataracts are a leading cause of visual impairment and blindness in children worldwide. Surgical intervention, particularly intraocular lens (IOL) implantation, is widely used to treat this condition. However, the outcomes of IOL surgery in paediatric populations remain uncertain due to varying clinical results and postoperative complications.

Objective:

To systematically evaluate and quantify the clinical efficacy of IOL implantation surgery for treating paediatric cataracts, based on improvements in visual acuity and the incidence of common postoperative complications.

Main findings:

The systematic review and meta-analysis included seven studies comprising data from 328 eyes of children who underwent IOL implantation. Of these, five were prospective randomised controlled trials, one was a prospective non-randomised controlled trial, and one was a retrospective case-control study. Four of the studies were conducted in China, with others from Iran, Austria, and India.

The review found consistent evidence of significant improvement in postoperative visual acuity among children receiving IOL incarceration surgery compared to non-incarceration methods (RR = 2.00, 95% CI: 1.18–3.37, P = 0.01). The procedure was also associated with a reduced risk of IOL deviation (RR = 0.28, 95% CI: 0.17–0.46, P < 0.00001) and moderate or greater central visual axis opacification (RR = 0.35, 95% CI: 0.19–0.65, P = 0.0007). However, no significant differences were found in posterior synechiae (RR = 0.67, 95% CI: 0.10–4.33, P = 0.67) or very mild visual axis opacification (RR = 1.05, 95% CI: 0.64–1.73, P = 0.84).

Study quality was assessed using the Cochrane risk of bias tool and Newcastle-Ottawa Scale. Moderate heterogeneity was observed, particularly for synechiae, which was addressed via sensitivity analysis. The results support the clinical benefits of IOL incarceration surgery while underscoring the need for improved postoperative care.

Methodology: 

A systematic review and meta-analysis was conducted on studies published from January 2000 to January 2021. Databases searched included CNKI, Wanfang, PubMed, Embase, the Cochrane Library, and relevant journal print editions. Inclusion criteria required pre- and postoperative visual acuity outcomes in children aged 14 years or younger. Two reviewers independently screened, extracted data, and assessed study quality. Meta-analyses were performed using RevMan 5.4, calculating mean differences for continuous outcomes and pooled incidence rates for complications. Heterogeneity was assessed using I² and Chi-square statistics.

Applicability/external validity:

The review’s findings have moderate applicability to broader paediatric cataract populations in similar clinical and surgical settings. However, generalisability is limited due to a predominance of Chinese studies, variability in surgical techniques and outcome definitions, and lack of multi-country RCTs. Although most included studies were RCTs, many had an unclear or high risk of bias. Further large-scale, high-quality studies across diverse regions are needed for broader validation.

Geographic focus:

China, Iran, Austria, and India

Summary of quality assessment:

There is medium confidence in the review’s conclusions. Limitations include a restricted search period (2000–2020) without justification, lack of a list of excluded studies, no exploration of heterogeneity sources, and failure to stratify results by risk of bias or address unit of analysis errors.