Acellular Dermal Allografts for Lower Eyelid Retraction Correction: A Systematic Review and Single-Arm Meta-Analysis.

Abstract

Lower eyelid retraction is caused by neurogenic, myogenic, mechanical, and congenital factors. The effectiveness and safety of acellular dermal allografts for this condition remain uncertain. This systematic review and single-arm meta-analysis aims to evaluate the effectiveness of acellular dermal allografts in correcting lower eyelid retraction. A systematic search of PubMed, Embase, Scopus, and Cochrane was performed to identify studies using acellular dermal allografts for lower eyelid retraction correction. Outcomes included margin reflex distance 2 (MRD2) improvement, inferior scleral show (ISS) improvement, complications, and reoperation rates. Statistical analyses were conducted using R Studio, and heterogeneity was assessed with I2 statistics. Fifteen studies with 330 participants (413 eyelids) were included. The pooled mean change in MRD2 was 2.12 mm (95% CI, 1.63-2.61 mm; I2 = 94.69%, P < 0.001), reduced to I2 = 66% after excluding Graves' disease-only studies. ISS improved by 2.21 mm (95% CI, 1.23-3.19 mm; I2 = 96.22%, P < 0.001). Complication and reoperation rates were 8.97% and 0.04%, respectively. Common complications included granulomas, pain, tearing, and discharge. Acellular dermal matrix grafts demonstrate the effectiveness and safety of lower eyelid retraction correction.