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

Wang, Jianfeng; Shen, Haiyang; Liu, Tao; Li, Qian; Zhaoyang, Lyu,; Yu, Youtao

doi:10.1007/s00266-021-02224-4

Cited by 14 publications

(13 citation statements)

References 21 publications

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“…31 The treatment of autologous fat-associated embolism is hampered by the lack of effective thrombolytics, 32 whereas the thrombolytic treatment of HA-associated embolism lacks supporting evidence. 33 Under such circumstances, Tansatit et al 34 reported improving the technique for arterial bypass surgery, and Wang et al 35 successfully used intraarterial mechanical recanalization, with both of these approaches showing significant potential. Recently, hyperbaric oxygen therapy has been found to significantly improve the oxygen supply at the embolic site, thereby inhibiting tissue necrosis.…”

Section: Discussionmentioning

confidence: 99%

Clinical Manifestations and Prognosis of Embolism Caused by Filler Injection in Different Facial Regions

Zhuang,

Zheng,

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background: Embolism is a serious complication after facial filling, with a usually poor prognosis of the symptoms after embolism. The authors systematically reviewed reported cases of facial vascular embolism, explored the relationship between the location and material used for facial filling and occurrence of vascular embolism, and assessed the prognosis of complications after vascular embolism. Methods: This study provides a systematic review of published cases of vascular embolism after facial filling. A summary of the filling materials and filling sites for each case, the adverse reactions and embolized blood vessels, a recording of the time when each patient experienced adverse reactions and started treatment, and a presentation of their prognosis are provided. Results: The frontal, eyebrow, and nose are common filling sites causing facial embolism. The main clinical manifestations after embolism were visual impairment, skin necrosis, and ptosis. The prognosis of visual impairment after embolization was poor, whereas skin necrosis and ptosis generally improved after treatment. Conclusions: This article aimed to review the clinical manifestations, therapies, and prognosis of embolism after facial filling. A better understanding of these complications can help clinicians to detect the occurrence of complications as early as possible and give patients timely treatment.

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Section: Discussionmentioning

confidence: 99%

Clinical Manifestations and Prognosis of Embolism Caused by Filler Injection in Different Facial Regions

Zhuang,

Zheng,

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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“…Wang et al retrospectively reviewed 30 patients with HA filler-induced monocular blindness treated with intra-arterial injections of hyaluronidase and mechanical recanalization. Among these patients, 12 were treated within 48 h, showing visual improvement in four cases, while only one patient with increased visual acuity was observed among those treated at later time points [ 24 ]. Nguyen et al combined intra-arterial hyaluronidase administration with additional thrombolytic agents (alteplase) in one case, achieving significant vision recovery [ 25 ].…”

Section: Discussion Of Managementmentioning

confidence: 99%

Sudden vision loss and neurological deficits after facial hyaluronic acid filler injection

Lucaciu

Samp

Hattingen

et al. 2022

Neurol. Res. Pract.

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Background The ongoing expansion of the cosmetic armamentarium of facial rejuvenation fails to uncover the inherent risks of cosmetic interventions. Informed consent to all risks of cosmetic filler injections and potential sequelae, including ocular and neurological complications, should be carefully ensured. We present two cases of complications following facial hyaluronic acid filler injections. Case presentations Case 1: A 43-year-old woman presented with monocular vision loss of the left eye, associated ptosis, ophthalmoplegia, periocular pain and nausea, cutaneous changes of the glabella region and forehead, and sensory impairment in the left maxillary branch dermatome (V2) after receiving a hyaluronic acid (HA) filler injection into the left glabellar area. On ophthalmological examination, an ophthalmic artery occlusion (OAO) was diagnosed upon identification of a “cherry-red spot”. Magnetic resonance imaging (MRI) revealed a left ischemic optic neuropathy. Supportive therapy and hyaluronidase injections were initiated. A follow-up MRI of the head performed two months after presentation corresponded to stable MRI findings. The patient had irreversible and complete vision loss of the left eye, however, the ptosis resolved. Case 2: A 29-year-old woman was admitted to hospital a few hours after a rhinoplasty and cheek augmentation with hyaluronic acid, presenting with acute monocular vision loss in the right eye, retrobulbar pain, fatigue and vomiting. In addition, the patient presented a harbinger of impending skin necrosis and a complete oculomotor nerve palsy on the right side, choroidal ischemia and vision impairment. Supportive treatment and hyaluronidase injections into the ischemic tissue were initiated. A small scar at the tip of the nose, vision impairment and an irregular pupillary margin on the right side persisted at follow-up. Conclusion These two case reports and the literature review emphasize the pathophysiological mechanisms leading to potentially devastating complications. In order to reduce the risk of vision loss secondary to cosmetic filler injections, practitioners should possess a thorough knowledge of anatomy and preventive strategies.

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“…This may be because of the technically challenging nature of retro-bulbar injections, with imprecise delivery of the enzyme into the vicinity of the CRA, or may be in part influenced by impaired diffusion across the arterial wall in the retro-orbital compartment. Fortunately, intra-arterial therapy has demonstrated a modest, but encouraging degree of success in the reversal of CRAO, especially when intervention is administered early and is combined with thrombolytic therapy [ 211 , 212 ]. Nonetheless, therapeutic success rates are still suboptimal, as evidenced by the poor outcomes reported in multiple animal and human interventional studies, likely due to delays in therapy [ 181 , 213 , 214 ].…”

Section: Pathophysiology Of Ha-mediated Vascular Occlusionmentioning

confidence: 99%

Bridging a Century-Old Problem: The Pathophysiology and Molecular Mechanisms of HA Filler-Induced Vascular Occlusion (FIVO)—Implications for Therapeutic Interventions

Soares

2022

Molecules

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Biocompatible hyaluronic acid (HA, hyaluronan) gel implants have altered the therapeutic landscape of surgery and medicine, fostering an array of innovative products that include viscosurgical aids, synovial supplements, and drug-eluting nanomaterials. However, it is perhaps the explosive growth in the cosmetic applications of injectable dermal fillers that has captured the brightest spotlight, emerging as the dominant modality in plastic surgery and aesthetic medicine. The popularity surge with which injectable HA fillers have risen to in vogue status has also brought a concomitant increase in the incidence of once-rare iatrogenic vaso-occlusive injuries ranging from disfiguring facial skin necrosis to disabling neuro-ophthalmological sequelae. As our understanding of the pathophysiology of these injuries has evolved, supplemented by more than a century of astute observations, the formulation of novel therapeutic and preventative strategies has permitted the amelioration of this burdensome complication. In this special issue article, we review the relevant mechanisms underlying HA filler-induced vascular occlusion (FIVO), with particular emphasis on the rheo-mechanical aspects of vascular blockade; the thromboembolic potential of HA mixtures; and the tissue-specific ischemic susceptibility of microvascular networks, which leads to underperfusion, hypoxia, and ultimate injury. In addition, recent therapeutic advances and novel considerations on the prevention and management of muco-cutaneous and neuro-ophthalmological complications are examined.

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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

Cited by 14 publications

References 21 publications

Clinical Manifestations and Prognosis of Embolism Caused by Filler Injection in Different Facial Regions

Clinical Manifestations and Prognosis of Embolism Caused by Filler Injection in Different Facial Regions

Sudden vision loss and neurological deficits after facial hyaluronic acid filler injection

Bridging a Century-Old Problem: The Pathophysiology and Molecular Mechanisms of HA Filler-Induced Vascular Occlusion (FIVO)—Implications for Therapeutic Interventions

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