Purpose

To compare the safety and functional outcomes of autologous bone grafts versus alloplastic implants in orbital floor reconstruction.

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Methods

A PRISMA-compliant systematic review and meta-analysis (PROSPERO: CRD420251140583) was performed using PubMed, Scopus, Web of Science, and Cochrane Library databases through August 2025. Comparative studies evaluating postoperative diplopia, enophthalmos, ectropion, infection, and implant malposition were included. Random-effects models generated pooled risk ratios (RR) with 95% confidence intervals.

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Results

Twenty studies involving 2,119 patients were included. Alloplastic implants significantly reduced postoperative ectropion risk compared with autologous grafts (RR=2.245, p=0.020). Sensitivity analysis demonstrated higher implant malposition rates in the autologous group (RR=2.074, p=0.004). Autologous reconstruction also showed a trend toward increased postoperative pain and donor-site morbidity. No significant differences were observed for infection, diplopia, or enophthalmos.

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Conclusion

Alloplastic implants provide comparable functional outcomes with superior periocular safety and avoidance of donor-site morbidity. These findings support alloplastic biomaterials as the preferred option for routine orbital floor reconstruction.

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Additional Authors

First name	Last name	Base Hospital / Institution
Ahmed	Samy Gad	Faculty of Medicine, Assiut University, Assiut, Egypt
Ahmad	Omar Saleh	Faculty of Medicine, The University of Jordan, Amman, Jordan
Mohamed	Mahmoud Fathy	Faculty of Medicine, Al Azhar University, New Damietta, Egypt
Abdelrahman	A. Ebaid	Faculty of Medicine, Qena University, Qena, Egypt
Amir	Majdi Moh’d	Faculty of Medicine, Yarmouk University, Irbid, Jordan
Raneem	Abuqtaish	Faculty of Medicine, The Hashemite University, Zarqa, Jordan
Mahmoud	Abdelbaki	Military Medical Academy, Cairo, Egypt
Amr	Elzahy	Faculty of Medicine, Alexandria University, Alexandria, Egypt

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