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Outcomes were analysed using random-effects models. Statistical analyses employed random-effects models and I\n                      <jats:sup>2<\/jats:sup>\n                      statistic. The protocol was registered with the Open Science Framework (OSF) (DOI:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/doi.org\/10.17605\/OSF.IO\/EZDWG\">https:\/\/doi.org\/10.17605\/OSF.IO\/EZDWG<\/jats:ext-link>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 103 screened articles, seven studies (comprising 856 patients) were included for meta-analysis. The 1:200,000 infiltrative adrenaline had significantly higher bleeding risk (15.3%, 95% CI: 11.1\u201320.5%) than 1:100,000 (3.8%, 95% CI: 2.0\u20136.5%) and 1:80,000 (2.0%, 95% CI: 0.7\u20134.3%), with an absolute risk difference of +13.3% (95% CI:\u2009+\u20099.8\u201316.8%, p\u2009&lt;\u20090.0001) between 1:200,000 and 1:80,000. No significant difference existed between 1:100,000 and 1:80,000 (RD=+1.8%, 95% CI: \u22121.2\u20134.7%, p\u2009=\u20090.23). Each 100,000-fold dilution increased absolute bleeding risk by 12.1% (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001), with a number needed to treat (NNT) of 8 favouring 1:80,000 or 1:100,000 over 1:200,000.\n                    <\/jats:p>\n                    <jats:p>\n                      The most common infiltrative concentrations (n\u2009=\u20098,648) were 1:100,000 (57%), 1:200,000 (23%), and 1:80,000 (18%). For topical applications (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u20096,343), 1:1,000 (48%) and 1:100,000 (22%) predominated. While no particular topical concentration showed superior haemostasis (p\u2009&gt;\u20090.05), 30-min 1:1,000 adrenaline application reduced bleeding vs. 5-min use (p\u2009&lt;\u20090.05). Rare complications included ocular and cardiovascular events.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>1:100,000 or 1:80,000 infiltrative adrenaline is preferred over 1:200,000 for lower bleeding risks, while topical adrenaline benefits from prolonged 30-min application. Surgeons should remain vigilant for rare systemic complications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/11206721251394939","type":"journal-article","created":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T18:28:32Z","timestamp":1770316112000},"page":"817-829","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy and safety of different Adrenaline concentrations in endoscopic dacryocystorhinostomy: A systematic review and meta-analysis"],"prefix":"10.1177","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0602-3479","authenticated-orcid":false,"given":"Andre","family":"Ma","sequence":"first","affiliation":[{"name":"Hong Kong Eye Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun Wah","family":"Lam","sequence":"additional","affiliation":[{"name":"Hong Kong Eye Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hammam Abdullah","family":"Alotaibi","sequence":"additional","affiliation":[{"name":"Prince Sultan Military Medical City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6363-9202","authenticated-orcid":false,"given":"Mohammad Javed","family":"Ali","sequence":"additional","affiliation":[{"name":"L.V. 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