Matheus Pedrotti Chavez, Filipe José Pereira, Eric Pasqualotto, Gherusa Helena Milbratz, Sara Hira, Tiago Tomaz de Souza, Jeremiah Tao
{"title":"氨甲环酸用于眼睑成形术：随机对照试验的系统回顾和荟萃分析。","authors":"Matheus Pedrotti Chavez, Filipe José Pereira, Eric Pasqualotto, Gherusa Helena Milbratz, Sara Hira, Tiago Tomaz de Souza, Jeremiah Tao","doi":"10.1097/IOP.0000000000002953","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Periorbital ecchymosis and edema are common postoperative concerns in blepharoplasty surgery, negatively impacting recovery and patient satisfaction. Tranexamic acid (TXA), an antifibrinolytic agent, has shown promise in mitigating ecchymosis, but its efficacy and optimal administration route remain uncertain. This systematic review and meta-analysis evaluated the efficacy and safety of intravenous (IV) or subcutaneous TXA in blepharoplasty surgery.</p><p><strong>Methods: </strong>A systematic search was conducted on PubMed, Embase, and Cochrane for randomized controlled trials comparing TXA to no TXA use in blepharoplasty. The primary endpoint was the ecchymosis score, evaluated at postoperative day (POD) 0, POD 1-3, and POD 7-9. Secondary outcomes included time to resume active daily living, operative time, intraoperative pain, and adverse events. Subgroup analysis compared IV and subcutaneous administration.</p><p><strong>Results: </strong>Five randomized controlled trials comprising 594 patients and 739 eyes were included. TXA significantly reduced ecchymosis scores at POD 0 (standardized mean difference [SMD]: -0.23; 95% confidence interval [CI]: -0.43 to -0.04; p = 0.02), POD 1-3 (SMD: -0.56; 95% CI: -0.81 to -0.31; p < 0.01), POD 7-9 (SMD: -0.65; 95% CI: -1.12 to -0.17; p < 0.01), and time to resume active daily living (MD: -1.22 days; 95% CI: -1.63 to -0.80; p < 0.01). Subgroup analysis revealed significant differences between subcutaneous (SMD: -0.36; 95% CI: -0.57 to -0.15; p < 0.01) and IV TXA (SMD: -0.97; 95% CI: -1.37 to -0.56; p < 0.01) on ecchymosis at POD 7-9. There were no adverse events related to TXA.</p><p><strong>Conclusions: </strong>According to the current literature, TXA safely reduces ecchymosis and accelerates recovery in blepharoplasty, with a greater effect of IV administration in the late period. Further, high-quality randomized controlled trials using standardized ecchymosis grading scores are needed to validate these findings.</p>","PeriodicalId":19588,"journal":{"name":"Ophthalmic Plastic and Reconstructive Surgery","volume":" ","pages":""},"PeriodicalIF":1.2000,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Tranexamic Acid for Blepharoplasty Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.\",\"authors\":\"Matheus Pedrotti Chavez, Filipe José Pereira, Eric Pasqualotto, Gherusa Helena Milbratz, Sara Hira, Tiago Tomaz de Souza, Jeremiah Tao\",\"doi\":\"10.1097/IOP.0000000000002953\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Periorbital ecchymosis and edema are common postoperative concerns in blepharoplasty surgery, negatively impacting recovery and patient satisfaction. Tranexamic acid (TXA), an antifibrinolytic agent, has shown promise in mitigating ecchymosis, but its efficacy and optimal administration route remain uncertain. This systematic review and meta-analysis evaluated the efficacy and safety of intravenous (IV) or subcutaneous TXA in blepharoplasty surgery.</p><p><strong>Methods: </strong>A systematic search was conducted on PubMed, Embase, and Cochrane for randomized controlled trials comparing TXA to no TXA use in blepharoplasty. The primary endpoint was the ecchymosis score, evaluated at postoperative day (POD) 0, POD 1-3, and POD 7-9. Secondary outcomes included time to resume active daily living, operative time, intraoperative pain, and adverse events. Subgroup analysis compared IV and subcutaneous administration.</p><p><strong>Results: </strong>Five randomized controlled trials comprising 594 patients and 739 eyes were included. TXA significantly reduced ecchymosis scores at POD 0 (standardized mean difference [SMD]: -0.23; 95% confidence interval [CI]: -0.43 to -0.04; p = 0.02), POD 1-3 (SMD: -0.56; 95% CI: -0.81 to -0.31; p < 0.01), POD 7-9 (SMD: -0.65; 95% CI: -1.12 to -0.17; p < 0.01), and time to resume active daily living (MD: -1.22 days; 95% CI: -1.63 to -0.80; p < 0.01). Subgroup analysis revealed significant differences between subcutaneous (SMD: -0.36; 95% CI: -0.57 to -0.15; p < 0.01) and IV TXA (SMD: -0.97; 95% CI: -1.37 to -0.56; p < 0.01) on ecchymosis at POD 7-9. There were no adverse events related to TXA.</p><p><strong>Conclusions: </strong>According to the current literature, TXA safely reduces ecchymosis and accelerates recovery in blepharoplasty, with a greater effect of IV administration in the late period. Further, high-quality randomized controlled trials using standardized ecchymosis grading scores are needed to validate these findings.</p>\",\"PeriodicalId\":19588,\"journal\":{\"name\":\"Ophthalmic Plastic and Reconstructive Surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.2000,\"publicationDate\":\"2025-05-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Ophthalmic Plastic and Reconstructive Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/IOP.0000000000002953\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"OPHTHALMOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Ophthalmic Plastic and Reconstructive Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/IOP.0000000000002953","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"OPHTHALMOLOGY","Score":null,"Total":0}
Tranexamic Acid for Blepharoplasty Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Background: Periorbital ecchymosis and edema are common postoperative concerns in blepharoplasty surgery, negatively impacting recovery and patient satisfaction. Tranexamic acid (TXA), an antifibrinolytic agent, has shown promise in mitigating ecchymosis, but its efficacy and optimal administration route remain uncertain. This systematic review and meta-analysis evaluated the efficacy and safety of intravenous (IV) or subcutaneous TXA in blepharoplasty surgery.
Methods: A systematic search was conducted on PubMed, Embase, and Cochrane for randomized controlled trials comparing TXA to no TXA use in blepharoplasty. The primary endpoint was the ecchymosis score, evaluated at postoperative day (POD) 0, POD 1-3, and POD 7-9. Secondary outcomes included time to resume active daily living, operative time, intraoperative pain, and adverse events. Subgroup analysis compared IV and subcutaneous administration.
Results: Five randomized controlled trials comprising 594 patients and 739 eyes were included. TXA significantly reduced ecchymosis scores at POD 0 (standardized mean difference [SMD]: -0.23; 95% confidence interval [CI]: -0.43 to -0.04; p = 0.02), POD 1-3 (SMD: -0.56; 95% CI: -0.81 to -0.31; p < 0.01), POD 7-9 (SMD: -0.65; 95% CI: -1.12 to -0.17; p < 0.01), and time to resume active daily living (MD: -1.22 days; 95% CI: -1.63 to -0.80; p < 0.01). Subgroup analysis revealed significant differences between subcutaneous (SMD: -0.36; 95% CI: -0.57 to -0.15; p < 0.01) and IV TXA (SMD: -0.97; 95% CI: -1.37 to -0.56; p < 0.01) on ecchymosis at POD 7-9. There were no adverse events related to TXA.
Conclusions: According to the current literature, TXA safely reduces ecchymosis and accelerates recovery in blepharoplasty, with a greater effect of IV administration in the late period. Further, high-quality randomized controlled trials using standardized ecchymosis grading scores are needed to validate these findings.
期刊介绍：
Ophthalmic Plastic and Reconstructive Surgery features original articles and reviews on topics such as ptosis, eyelid reconstruction, orbital diagnosis and surgery, lacrimal problems, and eyelid malposition. Update reports on diagnostic techniques, surgical equipment and instrumentation, and medical therapies are included, as well as detailed analyses of recent research findings and their clinical applications.
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