点阵二氧化碳激光对眶周皮肤年轻化有效性、安全性和满意度的系统综述及荟萃分析

A Systematic Review and Meta-Analysis of Efficacy, Safety, and Satisfaction Rates of Fractional CO₂ Laser in Periocular Skin Rejuvenation

摘要: 目的：点阵CO₂激光疗法在改善皮肤老化方面已经得到了广泛的应用，由于眶周皮肤的脆弱、易造成瘢痕的特性，目前针对眶周皮肤年轻化的激光治疗开展较少。本研究旨在确定点阵CO₂激光联合疗法在眶周皮肤再生表面修复中的有效性和安全性。方法：截至2023年12月01号，在3个主要数据库中进行了系统搜索。纳入的研究包括点阵CO₂激光或联合其他疗法来改善眼周老化的有效性及并发症，并报告了治疗的有效性和安全性；多篇文章报道同一组患者时，选择最近的报道完整数据的文章。排除标准包括体外研究、动物研究、未使用点阵CO₂激光、专家述评、书信、会议摘要、数据不完整或不能获取、CO₂点阵激光治疗但未声明关于眶周皱纹或年轻化的研究。结果：筛选后纳入7项临床试验，共纳入166例患者。研究汇总发现眶周皮肤老化及皱纹深度绝大部分都得到了改善，大多数患者都对这项技术感到满意。研究中发现患者在CO₂激光术后耐受性良好，主要产生的并发症有包括红斑(n = 8)、色素沉着过度(n = 8)、渗出、渗血、局部水肿、结痂、疼痛、灼热、瘙痒、水疱等。随访时均再未观察到疱疹感染等其他不良反应。术后7天无瘢痕及表皮萎缩再形成。大多数并发症轻微且短暂。治疗后红斑发生率为0.10 (95% CI: 0.03~0.18, p < 0.01)，色素沉着发生率为0.08 (95% CI: 0.03~0.16, p < 0.01)。结论：研究发现，点阵CO₂激光治疗眶周皮肤年轻化是有效且安全的。由于缺乏高质量的报告，有必要进行更多的试验来证实这些结果。

Abstract: Objective: Fractional CO₂ laser therapy has been widely used in improving skin aging. Due to the fragile and scarring properties of periorbital skin, laser therapy for periorbital skin rejuvenation is rarely carried out now. The aim of this study was to determine the efficacy and safety of fractional CO₂ laser combined therapy in periorbital skin regeneration surface repair. Methods: As of December 01, 2023, a systematic search was conducted in three major databases. Included studies included the efficacy and complications of fractional CO₂ laser or combined with other therapies to improve periocular aging, and reported the efficacy and safety of the treatment. When multiple articles report on the same group of patients, select the most recent article reporting complete data. Exclusion criteria included in vitro studies, animal studies, no use of a fractional CO₂ laser, expert reviews, letters, conference abstracts, incomplete or unavailable data, and studies on periorbital wrinkles or rejuvenation that did not claim fractional CO₂ laser treatment. Results: After screening, 7 clinical trials were included, involving a total of 166 patients. The study summary found that periorbital skin aging and wrinkle depth were largely improved, and most patients were satisfied with this treatment. The study found that patients were well tolerated after fractional CO₂ laser surgery, and the main complications included erythematosis (n = 8), hyper pigmentation (n = 8), exudation, bleeding, local edema, scab, pain, burning, pruritus, blisters, etc. No other adverse reactions such as herpes infection were observed during follow-up. No scar or epidermal atrophy was found 7 days after surgery. Most complications were mild and short-lived. The incidence of erythema after treatment was 0.10 (95% CI: 0.03~0.18, p < 0.01), and the incidence of hyper pigmentation was 0.08 (95% CI: 0.03~0.16, p < 0.01). Conclusion: It is found that fractional CO₂ laser is effective and safe in the treatment of periorbital skin rejuvenation. Due to paucity of high-quality reportings, additional trials are warranted to corroborate these results.