Comparison Of Hydrophilic Versus Hydrophobic Intraocular Lenses In Pediatric Cataract Surgery: A Meta-Analysis

To compare the long-term efficacy, safety, and complication rates of hydrophilic and hydrophobic intraocular lenses (IOLs) in pediatric cataract surgery. Pediatric cataracts are a leading cause of treatable childhood blindness, and selecting the optimal IOL material remains controversial due to the high risk of posterior capsule opacification (PCO) in developing eyes. This meta-analysis evaluates whether hydrophobic materials, which are the standard of care in adults for reducing PCO, offer similar clinical advantages in children. By synthesizing global data, this study aims to provide evidence-based guidance for lens selection across diverse clinical and economic settings.

This systematic review and meta-analysis synthesized data from international multi-center studies and randomized controlled trials. Research was included from a variety of global healthcare environments, including the USA, Germany, Australia, India, Iran, China, Brazil, and Nepal. These settings represent a broad spectrum of surgical practices and socio-economic contexts, ranging from high-resource academic medical centers to regions where cost-effective PMMA lenses remain prevalent.

Following PRISMA guidelines, we searched MEDLINE, EMBASE, and the Cochrane Library for randomized controlled trials (RCTs) and observational studies comparing hydrophilic (including PMMA) and hydrophobic IOLs in children (aged 0 to 15 years). Primary outcomes were PCO rates and postoperative complications. Two independent reviewers performed data extraction and quality assessment using AHRQ standards. Statistical analysis was conducted using Review Manager 5.3 with a random-effects model. Results are reported as odds ratios (OR) for dichotomous variables and mean differences (MD) for continuous variables, with 95 percent confidence intervals (CI). Heterogeneity was assessed using the I-squared statistic.

Twelve studies (5 RCTs, 7 non-RCTs) involving 1,234 eyes from 966 patients met the inclusion criteria. The pooled analysis demonstrated no statistically significant difference in PCO rates between hydrophobic and hydrophilic/PMMA lenses (OR 0.98; 95 percent CI 0.51 to 1.87; P = 0.95). Moderate heterogeneity was observed (I-squared = 75 percent). Secondary outcomes revealed varying complication profiles; while some studies noted higher postoperative fibrin or uveitis with PMMA, rates of IOL dislocation and secondary glaucoma were comparable across groups. Subgroup analysis showed that the aggressive nature of the pediatric capsular environment appeared to outweigh the impact of IOL material on visual axis opacification.

This meta-analysis reveals that the PCO-reducing benefits of hydrophobic materials observed in adults do not translate to pediatric populations. In the aggressive inflammatory environment of the young eye, meticulous surgical technique likely supersedes lens material in determining long-term success. Our findings confirm that hydrophilic and PMMA lenses remain safe, effective, and viable options. This is of critical importance for global health, as it validates the use of affordable IOLs in resource-limited settings without compromising visual outcomes. Future large-scale RCTs are required to further explore these molecular interactions.