The Role of Tranexamic Acid in Oculoplastic Surgery: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

[PURPOSE] This study investigates the role of tranexamic acid in oculoplastic surgery.

[METHODS] The authors searched PubMed, Embase, and Cochrane for randomized clinical trials comparing tranexamic acid (TXA) with placebo. They used the R software, applying mean difference for continuous outcomes and standard mean difference for continuous outcomes assessed on different scales.

[RESULTS] The authors included 9 randomized clinical trials totaling 897 patients. Tranexamic acid did not reduce intraoperative bleeding, with a mean difference of -14.83 mL (95% confidence interval [CI]: -36.65 to 6.98). In the subgroup of patients undergoing dacryocystorhinostomy, there was a more pronounced trend, with a mean difference of -29.65 mL (95% CI: -61.07 to 1.76), though without statistical significance. In addition, TXA reduced the degree of periorbital ecchymosis, with a mean difference of -0.69 (95% CI: -1.13 to -0.25), and this reduction was more notable and only statistically significant with intravenous administration (mean difference of -0.78, 95% CI: -1.34 to -0.22). Regarding the surgeon's satisfaction with hemostasis and the visibility of the surgical field, only 2 studies demonstrated statistically significant results, both using intravenous TXA administration. The other 4 studies did not report any improvement: 2 used the subcutaneous route, and the remaining 2 used the intravenous route for TXA administration. Finally, no reduction in the surgical time was observed with the use of TXA in oculoplastic procedures.

[CONCLUSIONS] In conclusion, TXA did not reduce intraoperative bleeding. However, despite the weak evidence in this outcome, the drug significantly decreased the degree of periorbital ecchymosis in patients undergoing blepharoplasty using intravenous administration.