Efficacy of Retrobulbar Hyaluronidase Injection for Vision Loss Resulting from Hyaluronic Acid Filler Embolization

Abstract

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Severe vision loss caused by cosmetic filler augmentation: Case series with review of cause and therapy

“…Furthermore, too much volume of hyaluronidase injection (8 mL in this case) may have resulted in a magnification of pressure effect, which could have forced the hyaluronic acid further into the central retinal artery. Moreover, the time to treatment is always crucial: Zhu et al performed a study of retrobulbar hyaluronidase treatment and concluded that it is not possible to reverse visual acuity in patients with more than 4‐hours blindness even with hyaluronidase in the dosage of 1500–3000 units. In contrast, case 4 demonstrates that retrobulbar hyaluronidase injection can reverse the symptoms of ophthalmoplegia and ptosis, which results in the esthetic improvement of the eyes within 1 week.…”

Prevention and management of iatrogenic blindness associated with aesthetical filler injections

“…However, because fundoscopy was not performed prior to the treatment and was considered normal immediately after the visual loss reversal, and no angiographic or optic coherent tomography were done, it remains questionable if the visual loss was definitely caused by filler occlusion of retinal vessels; in addition, the patient presented with central nervous system symptoms that fully recovered by the time brain imaging studies were performed. Notwithstanding, Zhu et al reported failure of vision restoration in four patients they tried the retrobulbar technique; however, the treatment was given between 4 and 34 hr after onset of visual loss, far beyond the reasonable recovery time window of approximately 90 min expected for retinal recovery after vascular occlusion (DeLorenzi, ; Zhu et al, ). Commenting on Chestnut case, Fagien and Carruthers reinforce the importance of properly diagnosing if visual loss has indeed been caused by occlusion of the ophthalmic artery, in order for their promising theory to be indeed proved effective (Fagien & Carruthers, ).…”

“…Chestnut recently reported a case of hyaluronic acid associated unilateral blindness possibly reversed after the above technique was shortly applied after symptoms began (Chesnut, 2018). However, because fundoscopy was not per- (DeLorenzi, 2017;Zhu et al, 2017). Commenting on Chestnut case, Fagien and Carruthers reinforce the importance of properly diagnosing if visual loss has indeed been caused by occlusion of the ophthalmic artery, in order for their promising theory to be indeed proved effective (Fagien & Carruthers, 2018).…”

Invited Discussion on: Retrobulbar Injection for Hyaluronic Acid Gel Filler-Induced Blindness—A Review of Efficacy and Technique

“…I would however, respectfully disagree with the authors that the presence of functional reading vision itself would suggest against IRVC as an isolated peripheral branch retinal arteriolar occlusion is a potential scenario that might be detected by ophthalmoscopy and confrontational visual field assessment or subjective field loss by the patient that could preserve central (reading) vision also indicating an ophthalmic artery embolization with an occlusion sparing the macula. Since the beginning of these writings and up to the present and despite some anecdotal case reports of its successes [9,10] and failures [11], weak experimentation attempting to prove or disprove its effectiveness [12,13] and more recent animal models showing some promise [4], there is still no consensus.…”

“…In summary, IRVC is a serious problem that requires further research and practical solutions with cooperation across the specialties so we can arrive on consensus. The very fact that there appears to be some successes with RB rescue therapy [9][10][11] suggests that we are on to something, but we simply do not fully understand all of the complexities involved for potentially effective resolve. Despite the current lack of indisputable evidence of the ability to reverse IRVC, safe application of RB or PB technique skills can be taught to most physicians and presently should be considered by all qualified individuals to avoid delay in a potential treatment.…”