Eyelid Complications in Subciliary Versus Transconjunctival Approaches to Orbital and Zygomaticofacial Fractures: A Meta-Analysis
Bibliographic record
Abstract
Background/Objectives: Eyelid complications such as ectropion, entropion, scleral show, and visible scarring can lead to significant cosmetic and functional concerns following orbital and zygomaticofacial fracture repair. The subciliary and transconjunctival approaches are commonly used, but their relative complication risks remain debated. This study aimed to compare the risk of postoperative eyelid complications between these two approaches. Methods: A systematic review and meta-analysis were conducted in accordance with the PRISMA guidelines. The study protocol was registered with PROSPERO (CRD420251089460). PubMed, EMBASE, and the Cochrane Library were searched for studies published between 1 January 1990 and 15 June 2025. Data on study design, patient demographics, and complication rates were extracted following the PRISMA guidelines. The Newcastle–Ottawa scale was used for quality assessment. A random effects meta-analysis was performed using Comprehensive Meta-Analysis software (v4.0), and pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Results: Nineteen studies involving 2103 patients (1062 subciliary; 1041 transconjunctival) were included for analysis. The subciliary approach was associated with significantly higher risks of ectropion (OR = 2.94; 95% CI: 1.63–5.31), scleral show (OR = 2.33; 95% CI: 1.12–4.84), and visible scar (OR = 5.62; 95% CI: 1.65–19.18). In contrast, the transconjunctival approach carried a higher risk of entropion (OR = 0.17; 95% CI: 0.07–0.42). Between-study heterogeneity and publication bias were minimal. Conclusions: As compared with the transconjunctival approach, the subciliary incision is associated with higher risks of ectropion, scleral show, and scarring, whereas the transconjunctival approach carries a greater risk of entropion. These findings may help guide surgical decision-making and patient counseling regarding postoperative outcomes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.023 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.016 | 0.063 |
| Bibliometrics | 0.005 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".