Acellular Dermal Allografts for Lower Eyelid Retraction Correction

Background – 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. Objective – This systematic review and single-arm meta-analysis aims to evaluate the effectiveness of acellular dermal allografts in correcting lower eyelid retraction. Methods – 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. Results – 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. Conclusion – Acellular dermal matrix grafts demonstrate the effectiveness and safety of lower eyelid retraction correction.