Postoperative complications in preseptal versus retroseptal transconjunctival approaches: A systematic review and...

Surgical correction of orbital fractures demands precise anatomical dissection with minimal complications. Transconjunctival incisions (TI) offer superior cosmetic outcomes, with two main techniques-preseptal (PS) and retroseptal (RS)-differing in anatomical pathways and associated risks. This systematic review and meta-analysis aimed to compare postoperative complications between PS and RS approaches. A comprehensive search of PubMed, Scopus, Ovid SP, Embase, Cochrane Library, and grey literature up to December 31, 2024, identified relevant studies. Inclusion criteria followed PICOT: adult patients with orbital fractures undergoing TI, comparing PS and RS techniques, with ≥1-month follow-up. Three studies (one RCT-split face design, two retrospective) involving 305 patients (PS: 245, RS: 253) were included. Data extraction and risk of bias assessment were independently performed by two reviewers using Cochrane RoB 2 and ROBINS-I. Meta-analysis with a random-effects model showed no significant differences between PS and RS in overall complications (OR = 0.93, 95 % CI: 0.51-1.71), ectropion (OR = 0.50, 95 % CI: 0.04-5.53), or entropion (OR = 3.02, 95 % CI: 0.12-74.49). Both techniques demonstrate comparable safety. Due to the limited number of studies and small sample size, findings should be considered preliminary. Surgical approach should be individualised, guided by anatomy, function, and the surgeon's expertise. Further high-quality RCTs are needed to strengthen surgical recommendations.