A Report by the American Academy of Ophthalmology Ophthalmic Technology Assessment Committee Oculoplastics and Orbit Panel
Jeremiah P. Tao, MD,1 Vinay K. Aakalu, MD, MPH,2 Suzanne K. Freitag, MD,3 Rachel K. Sobel, MD,4 Jill A. Foster, MD,5 Edward J. Wladis, MD,6 Timothy J. McCulley, MD,7 Michael T. Yen, MD8
Ophthalmology, In Press, © 2020 by the American Academy of Ophthalmology. Click here for free access to the OTA.
Purpose: To review the published literature to determine the efficacy and safety of homeopathic agents or vitamins in reducing ecchymosis after oculofacial surgery or laser surgery.
Methods: A literature search was conducted in the PubMed database initially in December 2019 and updated in March 2020 to identify all studies in the English language literature on the use of homeopathic agents or vitamins in oculofacial procedures, including laser surgery. The search yielded 124 citations, and 11 articles met all inclusion criteria for this assessment. A panel methodologist then assigned a level of evidence rating for each study. Eleven studies met inclusion criteria; 9 were rated level I, and 2 were rated level III.
Results: The agents studied in the articles identified included oral or topical Arnica montana (AM), oral Melilotus extract, topical vitamin K oxide, and topical AM combined with Rhododendron tomentosum. Metrics to describe ecchymosis varied. In 7 controlled studies, perioperative AM provided no or negligible benefit versus placebo. In 2 studies, vitamin K cream was equivalent to placebo. One study of oral Melilotus extract had less ecchymosis compared with controls in paranasal and eyelid ecchymosis at postoperative day (POD) 7, but not at PODs 1 and 4. A lone cohort study of combined topical AM and R. tomentosum lacked objective metrics and adequate controls. No serious side effects from administration of homeopathic agents or vitamins were identified.
Conclusions: The current literature does not support the use of AM, vitamin K oxide, R. tomentosum, or Melilotus extract for reducing ecchymosis after oculofacial surgery or pulsed dye laser surgery.
1Gavin Herbert Eye Institute, University of California, Irvine School of Medicine, Irvine, California
2Illinois Eye and Ear Infirmary, University of Illinois College of Medicine at Chicago, Chicago, Illinois
3Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
4Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee
5Ophthalmic Surgeons and Consultants of Ohio, Columbus, Ohio
6Ophthalmic Plastic Surgery, Lions Eye Institute, Department of Ophthalmology, Albany Medical Center, Albany (Slingerlands), New York
7The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
8Cullen Eye Institute, Baylor College of Medicine, Houston, Texas