Abstract
Propose
To evaluate the efficacy and safety of recanalizing hyaluronic acid-occluded retinal central artery by intra-arterially infusing hyaluronidase.
Methods
Between December 2015 and December 2016, 30 patients with monocular blindness due to the injection of hyaluronic acid in facial tissue underwent ophthalmic artery recanalization. The outcome of the intra-arterial treatment was retrospectively reviewed. The fundus was examined 24 hours after the treatment to observe revisualization of the retinal arteries. The success rate of intra-arterial recanalization of the ophthalmic artery, procedure-related complications, visual acuity recovery, eyeball and eyelid movement restoration was followed up for up to 3 months.
Results
The success rate of ophthalmic arterial catheterization was 100%. No interventional procedure-related adverse events were found. Twenty-six patients presented ptosis and 23 patients presented ocular motility disorders. The ptosis disappeared and 18 patients had normal eye movement after the intra-arterial therapy. Five of the 30 patients had visual improvement and four patients with complete vision loss gained some light perception. After the intra-arterial thrombolysis, digital subtraction angiographic imaging revealed enlarged and numerous branches of the ophthalmic artery and a clearer ring around the eye.
Conclusion
Intra-arterial infusion of hyaluronidase and mechanical recanalization is an effective and safe approach for recovering the visual acuity in the patients with monocular blindness caused by the migration of hyaluronic acid injected in the facial tissues.
Level of Evidence IV
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.
Similar content being viewed by others
References
Carle MV, Roe R, Novack R, Boyer DS (2014) Cosmetic facial fillers and severe vision loss. JAMA Ophthalmol 132(5):637–639. https://doi.org/10.1001/jamaophthalmol.2014.498
Fagien S, Carruthers J (2018) Commentary on restoration of visual loss with retrobulbar hyaluronidase injection after hyaluronic acid filler. Dermatol Surg 44(3):437–443. https://doi.org/10.1097/DSS.0000000000001372
He MS, Sheu MM, Huang ZL, Tsai CH, Tsai RK (2013) Sudden bilateral vision loss and brain infarction following cosmetic hyaluronic acid injection. JAMA Ophthalmol 131(9):1234–1235. https://doi.org/10.1001/jamaophthalmol.2013.1603
Humzah MD, Ataullah S, Chiang C, Malhotra R, Goldberg R (2019) The treatment of hyaluronic acid aesthetic interventional induced visual loss (AIIVL): a consensus on practical guidance . J Cosmet Dermatol 18:71–76. https://doi.org/10.1111/jocd.12672
Beleznay K, Carruthers JD, Humphrey S, Jones D (2015) Avoiding and treating blindness from fillers: a review of the world literature. Dermatol Surg 41(10):1097–1117. https://doi.org/10.1097/DSS.0000000000000486
Carruthers JD, Fagien S, Rohrich RJ, Weinkle S, Carruthers A (2014) Blindness caused by cosmetic filler injection: a review of cause and therapy. Plast Reconstr Surg 134(6):1197–1201. https://doi.org/10.1097/PRS.0000000000000754
Lazzeri D, Agostini T, Figus M, Nardi M, Pantaloni M, Lazzeri S (2012) Blindness following cosmetic injections of the face. Plast Reconstr Surg 129(4):995–1012. https://doi.org/10.1097/PRS.0b013e3182442363
Loh KT, Chua JJ, Lee HM, Lim JT, Chuah G, Yim B, Puah BK (2016) Prevention and management of vision loss relating to facial filler injections. Singapore Med J 57(8):438–443. https://doi.org/10.11622/smedj.2016134
Goodman GJ, Clague MD (2016) A rethink on hyaluronidase injection, intraarterial injection, and blindness: Is there another option for treatment of retinal artery embolism caused by intraarterial injection of hyaluronic acid? Dermatol Surg 42(4):547–549. https://doi.org/10.1097/DSS.0000000000000670
Park SW, Woo SJ, Park KH, Huh JW, Jung C, Kwon OK (2012) Iatrogenic retinal artery occlusion caused by cosmetic facial filler injections. Am J Ophthalmol 154(4):653–662. https://doi.org/10.1016/j.ajo.2012.04.019
Chesnut C (2018) Restoration of visual loss with retrobulbar hyaluronidase injection after hyaluronic acid filler. Dermatol Surg 44(3):435–437. https://doi.org/10.1097/DSS.0000000000001237
Kim DY, Eom JS, Kim JY (2015) Temporary blindness after an anterior chamber cosmetic filler injection. Aesthet Plast Surg 39(3):428–430. https://doi.org/10.1007/s00266-015-0477-9
Prado G, Rodriguez-Feliz J (2017) Ocular pain and impending blindness during facial cosmetic injections: Is your office prepared? Aesthet Plast Surg 41(1):199–203. https://doi.org/10.1007/s00266-016-0728-4
Noble J, Weizblit N, Baerlocher MO, Eng KT (2008) Intra-arterial thrombolysis for central retinal artery occlusion: a systematic review. Br J Ophthalmol 92(5):588–593. https://doi.org/10.1136/bjo.2007.133488
Jeon JP, Cho YD, Han MH (2016) Intra-arterial thrombolysis of central retinal artery occlusion following percutaneous atrial septal defect closure. Catheter Cardiovasc Interv 88(1):157–160. https://doi.org/10.1002/ccd.26100
Thompson EM, Egan RA, Nesbit GM, Hills WL (2011) Rapid intra-arterial thrombolysis in stent-associated retinal artery occlusion. J Vascular Interv Radiol JVIR 22(3):410–412. https://doi.org/10.1016/j.jvir.2010.10.034
Biousse V, Calvetti O, Bruce BB, Newman NJ (2007) Thrombolysis for central retinal artery occlusion. J Neuroophthalmol 27(3):215–230. https://doi.org/10.1097/WNO.0b013e31814b1f66
Dattilo M, Biousse V, Newman NJ (2017) Update on the management of central retinal artery occlusion. Neurol Clin 35(1):83–100. https://doi.org/10.1016/j.ncl.2016.08.013
Hwang G, Woo SJ, Jung C, Park KH, Hwang JM, Kwon OK (2010) Intra-arterial thrombolysis for central retinal artery occlusion: two cases report. J Korean Med Sci 25(6):974–979. https://doi.org/10.3346/jkms.2010.25.6.974
Page PS, Cambon AC, James RF (2016) Visual Improvement after Intra-Arterial thrombolysis for central retinal artery occlusion does not correlate with time to treatment. Interv Neurol 5(3–4):131–139. https://doi.org/10.1159/000446853
Zhang L, Luo Z, Li J, Liu Z, Xu H, Wu M, Wu S (2021) Endovascular hyaluronidase application through superselective angiography to rescue blindness caused by hyaluronic acid injection. Aesthet Surg J 41(3):344–355. https://doi.org/10.1093/asj/sjaa036
Schmidt DP, Schulte-Monting J, Schumacher M (2002) Prognosis of central retinal artery occlusion: local intraarterial fibrinolysis versus conservative treatment. AJNR Am J Neuroradiol 23(8):1301–1307
Funding
None.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
The authors declare that they have no conflict of interest.
Ethics approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was waived because this was a retrospective study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Wang, J., Shen, H., Liu, T. et al. An Efficacy and Safety Study of Intra-arterial Recanalization of Occluded Ophthalmic Arteries in Patients with Monocular Blindness Caused by Injection of Hyaluronic Acid in Facial Tissues. Aesth Plast Surg 45, 1573–1578 (2021). https://doi.org/10.1007/s00266-021-02224-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00266-021-02224-4