Effectiveness of retrobulbar hyaluronidase in the treatment of visual loss caused by periocular hyaluronic acid injection. A systematic review

Navarro-Hernandez, E.; Pérez-López, Marta

doi:10.1016/j.oftale.2022.06.005

Cited by 5 publications

(4 citation statements)

References 58 publications

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“…Similarly, for management of visual impairments, local injection of hyaluronidase at the HA injection site [63], retroocular hyaluronidase injection [63], or intraarterial injection [16,60,63] as well as aspirin and a form of steroids (methylprednisolone, prednisone, dexamethasone, or steroid pulse) have been used [75]. However, recent systemic reviews [76,77] and a consensus opinion paper [78] suggested a limited success with retrobulbar hyaluronidase injection. Overall, there is no accepted universal protocol for the use of hyaluronidase in management of vascular complications caused by HA injections.…”

Section: Discussionmentioning

confidence: 99%

A Scoping Review of Hyaluronidase Use in Managing the Complications of Aesthetic Interventions

2022

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Background Hyaluronidase is used as an adjunct or main treatment to manage complications associated with cosmetic hyaluronic acid (HA) filler injections such as necrosis, blindness, hypersensitivity, delayed nodules, and poor aesthetic outcomes. Objective To systematically map the available evidence and identify the gaps in knowledge on the effectiveness of hyaluronidase use in managing the aesthetic complications associated with HA injections (vascular occlusion, blindness, nodules, delayed hypersensivity, granuloma, poor aesthetic outcome). Methods PubMed, Medline, Embase and Cochrane databases were used up to May 2022, to look for randomized clinical trials (RCTs), clinical trials, and retrospective case-control studies reporting on the use of hyaluronidase for managing the HA filler injection complications. Results The database search yielded 395 studies; of those 5 RCTs (all carried out in the USA) were selected (53 subjects), indicating the effectiveness of hyaluronidase for removal of un-complicated injected HA nodules (forearm, upper arm, or back skin). The follow-ups ranged from 14 days to 4 years. The amount of HA filler injected into each site varied from 0.2 to 0.4 mL. A dose dependent response was observed for most HA fillers. No major adverse reactions were reported. Overall, for removal of every 0.1 mL of HA filler they injected 1.25–37.5 units of hyaluronidase (single injections). When 3 consecutive weekly hyaluronidase injection was used much lower doses of 0.375–2.25 unit was utilised. There was no evidence in a form of RCTs, clinical trials, and retrospective case-control studies on the removal/reversal of HA injections in the facial skin, or management of over-corrections, inflammatory nodules, or tissue ischemia/necrosis associated with HA filler injection. Conclusion Based on studies on the forearm, upper arm and back skin, hyaluronidase can be used for the reversal of uncomplicated HA filler injection nodule. However, further adequately powered studies are warranted to establish the ideal treatment protocol/dose of hyaluronidase for reversal of HA filler injections in the facial region or management of complications associated with aesthetic HA injection. 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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Section: Discussionmentioning

confidence: 99%

A Scoping Review of Hyaluronidase Use in Managing the Complications of Aesthetic Interventions

2022

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“…Due to the extensive network of vascular anastomoses, the periocular region is prone to vascular disorders. The region of the glabella and nasal dorsum are the most dangerous areas in terms of the risk of vascular occlusion by filler particles [4].…”

Section: Discussionmentioning

confidence: 99%

“…Most of the recommendations focus on preventive care, such as vascular anatomy awareness and gradual retrograde injection using cannulas instead of needles [2]. Currently available treatment options include: high-dose hyaluronidase injections (both periocular and retrobulbar), intra-arterial thrombolysis in combination with intra-arterial hyaluronidase injection, traditional systemic thrombolytic therapy, eye massage, anterior chamber paracentesis, and hyperbaric oxygen therapy [3,4]. Of these, intraarterial thrombolysis in combination with intra-arterial injection of hyaluronidase seems the most effective, but this method requires appropriate specialists and equipment [5].…”

Section: Discussionmentioning

confidence: 99%

Reversible Vision Loss Following Nonsurgical Filler Rhinoplasty

Sheptulin

Grusha

2022

Russ Open Med J

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The increase in the frequency and popularity of aesthetic filler injections is accompanied by a high risk of complications, including ophthalmological sequalae. Of these, loss of vision is considered the most dangerous and, in most cases, irreversible. We present a case report of a patient who experienced acute vision loss due to suspected partial occlusion of the ophthalmic artery following nonsurgical rhinoplasty with hyaluronic acid filler injection. It differs from others in that treatment in the form of a combination of multiple subcutaneous hyaluronidase injections into the periocular region, a single retrobulbar injection of hyaluronidase, and hyperbaric oxygen therapy led to a significant recovery of ophthalmic symptoms with only residual visual field defects remaining.

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“…Retrobulbar and peribulbar injections of hyaluronidase may be beneficial for the treatment of vision loss resulting from hyaluronic acid injections, although this remains controversial and further research is required to confirm their efficacy 16,23,29,30 .…”

Section: • Vision Lossmentioning

confidence: 99%

Beyond the Aesthetics: Understanding Risks in Nonsurgical Rhinoplasty

Czach,

Kamińska,

et al. 2024

J Educ Health Sport

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Nonsurgical rhinoplasty (NSR), colloquially referred to as a "liquid nose job," is a procedure that employs injectable fillers to modify the shape and contour of the nose. This procedure is particularly suited to patients presenting with minor imperfections and nasal defects. The procedure typically entails the injection of hyaluronic acid-based fillers, which are preferred due to their reversibility and safety profile. Although rare, dangerous complications are possible, therefore it is important to be aware of the risks associated with performing NSR and how to recognise and manage them. This article examines a number of potential complications associated with the procedure, including minor side effects such as bruising and swelling, as well as more serious risks such as vascular obstruction, skin necrosis and blindness. It is evident that the practitioner's experience and anatomical knowledge are of paramount importance in order to minimise the aforementioned risks. The aim of this review is to delineate the potential hazards associated with NSR. It is imperative that both clinicians and patients are cognizant that NSR is not a risk-free procedure. Dissemination of information may facilitate the implementation of safer practices and superior outcomes in facial aesthetic procedures.

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Effectiveness of retrobulbar hyaluronidase in the treatment of visual loss caused by periocular hyaluronic acid injection. A systematic review

Cited by 5 publications

References 58 publications

A Scoping Review of Hyaluronidase Use in Managing the Complications of Aesthetic Interventions

A Scoping Review of Hyaluronidase Use in Managing the Complications of Aesthetic Interventions

Reversible Vision Loss Following Nonsurgical Filler Rhinoplasty

Beyond the Aesthetics: Understanding Risks in Nonsurgical Rhinoplasty

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