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Superselective Arterial Hyaluronidase Thrombolysis is an Effective Treatment for Hyaluronic Acid-Induced Retinal Artery Occlusion: Study in a Rabbit Model

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  • Basic Science/Experimental
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Abstract

Background

There are serious complications associated with hyaluronic acid (HA) facial injections, including vision impairment due to retinal artery ischemia. In this study, we put forth a clinically relevant model of retinal ischemia and reperfusion in rabbit. We used this to verify the efficacy of hyaluronidase intra-artery thrombolysis in the treatment of hyaluronic acid-induced retinal artery occlusion.

Methods

Retinal artery ischemia was induced by injecting HA into the ophthalmic artery (OA) of adult chinchilla rabbit, and reperfusion was achieved by intra-artery thrombolysis therapy with hyaluronidase following 60 min and 4 h of occlusion. Digital subtraction angiography (DSA) and fundus fluorescein angiography (FFA) were used to evaluate blood flow in the retina. Electroretinogram (ERG), hematoxylin and eosin staining and transmission electron microscope were used to evaluate the structure and function of the retina after ischemia and reperfusion following 60 min and 4 h of occlusion.

Results

DSA and FFA images confirmed occlusion of the ophthalmic and central retinal arteries, as well as reperfusion after hyaluronidase thrombolysis. ERG indicated retinal dysfunction following ischemia, and thrombolysis partially rescued its impairment following 4 h of occlusion. Hematoxylin and eosin staining and TUNEL staining revealed ischemia-induced histological damages in the retina at different time windows, and hyaluronidase thrombolysis partially mitigated these damages.

Conclusions

We report a method to establish a HA-induced retinal artery occlusion animal model. Hyaluronidase intra-artery thrombolysis was used to recanalize the embolized OA at different time points. Using our method, we achieved retinal reperfusion, and an improvement was observed in the visual function of rabbits after hyaluronidase thrombolysis following 4 h of occlusion. We believe that hyaluronidase intra-artery thrombolysis is an effective method to treat HA-induced retinal artery occlusion in clinic.

Level of Evidence II

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Funding

The fourth medical center of Chinese PLA General Hospital Innovation Science Fund (2024-4ZX-ZD-07).

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Author notes

  1. Xiao Xu and Xuer Sun have equally contributed to this work.

Authors and Affiliations

  1. Department of Ophthalmology, The Third Medical Center of Chinese PLA General Hospital, No. 69 Yongding Road, Haidian District, Beijing, 100039, China

    Xiao Xu & Xinji Yang

  2. Medical School of Chinese PLA, Beijing, China

    Xuer Sun & Can Zheng

  3. Department of Burns and Plastic Surgery, The Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Rd, Haidian District, Beijing, 100048, China

    Qiang Fu, Guiwen Zhou & Minliang Chen

  4. Department of Interventional Radiology, The Fourth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Rd, Haidian District, Beijing, 100048, China

    Yi Ning & Youtao Yu

Authors
  1. Xiao Xu
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  2. Xuer Sun
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  3. Qiang Fu
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  4. Guiwen Zhou
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  6. Can Zheng
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  7. Xinji Yang
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  8. Youtao Yu
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  9. Minliang Chen
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Corresponding authors

Correspondence to Xinji Yang, Youtao Yu or Minliang Chen.

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The authors declare that they have no conflict of interest.

Ethical Approval

All procedures were approved by the animal care and use committee of animal center in academy (IACUC-DWZX-2020-779).

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Xu, X., Sun, X., Fu, Q. et al. Superselective Arterial Hyaluronidase Thrombolysis is an Effective Treatment for Hyaluronic Acid-Induced Retinal Artery Occlusion: Study in a Rabbit Model. Aesth Plast Surg (2024). https://doi.org/10.1007/s00266-024-03891-9

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  • DOI: https://doi.org/10.1007/s00266-024-03891-9

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