Prevention and management of iatrogenic blindness associated with aesthetical filler injections

Lacerda, Davi de

doi:10.1111/dth.12722

Cited by 18 publications

(24 citation statements)

References 26 publications

(48 reference statements)

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“…Even though the efficacy and safety of aspirin and heparin have not been proven in hyaluronic acid related occlusions, studies have highlighted their potential of preventing thrombotic spreading [ 17 , 30 , 37 – 42 ]. The rationale behind the application of aspirin is based on extrapolation from other clinical settings, i.e.…”

Section: Discussion Of Managementmentioning

confidence: 99%

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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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Section: Discussion Of Managementmentioning

confidence: 99%

“…While Murray et al urge clinicians to consider potential risks of instituting steroid therapy, i.e. impaired wound healing and increased risk of infection [ 43 ], most studies acknowledge the potential of decreasing the inflammatory component of the injury [ 5 , 37 , 40 , 42 , 46 ].…”

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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“…Searching (not retrieved) 27. Prevention and management of iatrogenic blindness associated with aesthetical filler injections [70] Not related [71] Efficacy and safety of a hyaluronic acid filler to correct aesthetically detracting or deficient features of the Asian nose: a prospective, open-label, long-term study Not solid polymers 29. Application of a porous polyethylene spreader graft for nasal lengthening in Asian patients [72] Not dorsum separately 30.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of complications associated with polymer-based alloplastic materials in nasal dorsal augmentation: a systematic review and meta-analysis

Keyhan¹,

Ramezanzade²,

Yazdi³

et al. 2022

Maxillofac Plast Reconstr Surg

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Background Various techniques with different grafts and implants have been proposed to establish a smooth and symmetric nasal dorsum with adequate function. Broadly, two categories of materials have been used in this regard: alloplastic implant materials and autograft materials. The aim of these meta-analyses is to explore the incidence of complications after dorsum augmentation surgery using alloplastic materials. Materials and methods After duplication removal 491 papers remained that title and abstract were assessed for eligibility. Regarding the study type, 27 observational studies were included, 21 retrospective and 6 prospective case series. A total of 3803 cases were enrolled in this systematic review and meta-analysis. Result Twenty-seven articles reported on complications and outcomes of dorsal augmentation rhinoplasty with synthetic materials. In a random-effects model, the weighted mean percentage was 2.75% (95% CI 1.61 to 4.17%). the weighted mean percentage were 1.91% (95% CI 0.77 to 3.54%), 0.72% (95% CI 0.316 to 1.31%), and 0.78% (95% CI 0.43 to 1.24%) respectively. Conclusion The widely used alloplasts were expanded polytetrafluoroethylene (ePTFE), high-density polyethylene, and silicone. The total rates for complications, infection, deviation, irregularity, hematoma, extrusion, and overcorrection were 2.75%, 1.91%, 0.72%, 0.70%, 0.78%, and 0.49%, respectively. The revision rate, based on the random effects model, was 6.40% with 95%CI (3.84 to 9.57). Trial registration This meta-analysis was registered at the International Prospective Register of Systematic Reviews (PROSPERO, registration number CRD42020209644).

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“…Previous studies have reported that loss of vision is irreversible in most cases of ophthalmic vascular occlusion, and to date, no effective treatments have been developed. [ 8 ] Conventional treatments for spontaneous central retinal artery occlusion have been applied in the iatrogenic retinal artery occlusion. However, none of them showed favorable results.…”

Section: Discussionmentioning

confidence: 99%

Retinal artery occlusion following cosmetic injection of poly-L-lactic acid

2021

Taiwan Journal of Ophthalmology

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Ophthalmic vascular occlusion is an infrequent but devastating complication following cosmetic facial filler injection. We report a case of developing retinal artery occlusion after poly-L-lactic acid (PLLA) injection. A 49-year-old woman with multiple chronic diseases experienced sudden central visual loss and severe ocular pain in the right eye immediately after PLLA injection in the temporal region. Her best-corrected visual acuity in the right eye dropped from 20/20 to 20/200. Fundus photography showed marked optic disc edema and localized retinal whitening in the territory of the blocked vessels. Spectral-domain optical coherence tomography revealed localized hyperreflectivity of the inner retina and retinal edema. Fluorescein angiography showed delayed filling of the retinal arteries and absence of retinal perfusion in the affected areas. Despite prompt aggressive management of the condition with ocular massage, topical brimonidine eyedrops, and hyperbaric oxygen therapy, the patient suffered permanent visual loss due to optic atrophy. Among all the subcutaneous filler materials, PLLA has not been a common cause of vascular complications, especially when injected in the temporal region, as this area has not been considered dangerous in the previous literature. Practitioners should be aware of the risk of visual loss, and extra care should be given on those who originally have a higher risk for vascular complications.

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Prevention and management of iatrogenic blindness associated with aesthetical filler injections

Cited by 18 publications

References 26 publications

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

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

Prevalence of complications associated with polymer-based alloplastic materials in nasal dorsal augmentation: a systematic review and meta-analysis

Retinal artery occlusion following cosmetic injection of poly-L-lactic acid

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