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Administration Method and Potential Efficacy of Hyaluronidase for Hyaluronic Acid Filler-Related Vision Loss: A Systematic Review

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  • Non-Surgical Aesthetic
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Abstract

Background

With the global increase in the use of injectable fillers, more cases with serious adverse events such vision loss are being reported. This article aims to review the cases of hyaluronic acid (HA) filler-related vision loss and to discuss the potential efficacy of hyaluronidase (HYASE) treatment via different given methods.

Methods

A total of 29 articles presenting 144 cases of HA filler-related vision loss were included in this study.

Results

Most cases of HA filler-related vision impairment were reported from China, followed by Korea. The majority of cases were seen in women. The nose, forehead and glabella were the most commonly injection sites. All cases had vision impairment and nearly all cases were unilateral with immediate onset of visual signs and symptoms. Ophthalmic artery occlusion (OAO) and central retinal artery occlusion (CRAO) were the two most commonly involved arterial obstruction patterns featured with a very poor prognosis followed by branch retinal artery occlusion (BRAO), the most favorable involved arterial pattern for a better prognosis. HYASE given subcutaneously and intra-arterially helped with visual recovery to different degrees, while retrobulbar HYASE seemed to be less helpful.

Conclusion

Complications after HA-based filler injection are extremely rare but can cause disastrous visual impairment. HYASE given subcutaneously and intra-arterially helped with visual recovery to different extents, and the efficacy might be reinforced when performed together, while retrobulbar HYASE seemed to be less helpful. However, to accurately access the efficacy of HYASE via different administration methods, further randomized controlled trials are needed.

Level of Evidence III

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  1. Haodong Xiao, Wei Kou and Yuan Yang contributed equally to this study.

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  1. Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Floor 11, Building 19, 1665 Kongjiang Rd., Shanghai, 200092, China

    Haodong Xiao, Yuan Yang, Erkuan Dai, Xuerui Zhang, Yanjun Wen, Jie Peng, Ping Fei & Peiquan Zhao

  2. Ruijin Hospital Affiliated Shanghai Jiaotong University School of Medicine, Shanghai, China

    Wei Kou

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Xiao, H., Kou, W., Yang, Y. et al. Administration Method and Potential Efficacy of Hyaluronidase for Hyaluronic Acid Filler-Related Vision Loss: A Systematic Review. Aesth Plast Surg 48, 709–718 (2024). https://doi.org/10.1007/s00266-022-03215-9

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