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Vision Loss Associated with Hyaluronic Acid Fillers: A Systematic Review of Literature

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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 as skin ischemia and vision loss are being reported. This article aims to review the role of HA fillers, as a subgroup separate from fat graft and non-HA fillers, in causing vision loss and to elucidate various features and outcomes of post-HA filler vision loss.

Methods

The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were used to report this review. A total of 29 articles presenting 60 unique cases of post-HA filler vision loss were identified in the literature. Based on various inclusion and exclusion criteria, 26 articles with details of 44 cases were included in this study.

Results

The majority of cases were seen in women and in the 20–40 years age group. The maximum number of cases was reported from Korea, followed by China. Nearly half of the cases reported after HA filler-related visual complications had partial loss of sight, hence ‘partial vision loss’ and ‘complete vision loss’ were used as differentiating descriptive terms to the degree of ‘blindness.’ Nearly all the cases were unilateral, with immediate onset of visual signs and symptoms. The nose, glabella, and forehead were the most commonly implicated areas, while no cases of post-HA filler vision loss were reported from lower face anatomical areas, including the chin, jawline, and lips. Partial vision loss after HA filler has a better prognosis than complete vision loss. HA filler volumes as low as 0.2 ml can cause permanent, complete vision loss, which is suggestive of the embolic nature of HA filler blockage. Ophthalmic artery occlusion (OAO) and central retinal artery occlusion (CRAO) were the two most commonly involved arterial obstruction patterns followed by branch retinal artery occlusion (BRAO). BRAO is the most favorable involved arterial pattern for a chance of recovery after HA filler-related vision loss while CRAO and OAO patterns carry a very poor prognosis.

Conclusion

Post-HA filler vision loss is nearly always of immediate onset. Partial vision loss after HA filler injection with the involvement of smaller branches of the retina, other than central retinal artery or ophthalmic artery, has more favorable visual outcomes.

Level of Evidence III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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(Contributed by Dr. K. M. Kapoor)

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(Contributed by Dr. K. M. Kapoor)

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Abbreviations

AION:

Anterior ischemic optic neuropathy

BCVA:

Best-corrected visual acuity

BRAO:

Branch retinal artery occlusion

CNS:

Central nervous system

CRAO:

Central retinal artery obstruction

ECA:

External carotid artery

HA:

Hyaluronic acid

HM:

Hand movement

ICA:

Internal carotid artery

IU:

International unit

LP:

Light perception

LPS:

Levator palpebrae superioris

NLP:

No light perception

PCAO:

Posterior ciliary artery obstruction

PION:

Posterior ischemic optic neuropathy

PRISMA:

Preferred reporting items for systematic reviews and meta-analyses

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Authors and Affiliations

  1. Anticlock Clinic, #1508, Sector 33 D, Chandigarh, 160022, India

    Krishan Mohan Kapoor & Puneet Kapoor

  2. Department of Plastic Surgery, Fortis Hospital, Mohali, India

    Krishan Mohan Kapoor

  3. St George’s, University of London, London, UK

    Krishan Mohan Kapoor

  4. Cape Town Cosmetic Dermatology Centre, Central Park on Esplanade, Century City, Cape Town, South Africa

    Izolda Heydenrych

  5. Division of Dermatology, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa

    Izolda Heydenrych

  6. Maxillofacial Surgery Division, University of Verona, Verona, Italy

    Dario Bertossi

  7. Casa di cura La Madonnina, Studio Macaluso piazza Lima 1 Milano, Centro di medicina via montebaldo 12 Calzoni di Villafranca Verona, Milan, Italy

    Dario Bertossi

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  1. Krishan Mohan Kapoor
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Correspondence to Krishan Mohan Kapoor.

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Kapoor, K.M., Kapoor, P., Heydenrych, I. et al. Vision Loss Associated with Hyaluronic Acid Fillers: A Systematic Review of Literature. Aesth Plast Surg 44, 929–944 (2020). https://doi.org/10.1007/s00266-019-01562-8

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