Evaluation of Intraarterial Thrombolysis in Treatment of Cosmetic Facial Filler-Related Ophthalmic Artery Occlusion

Abstract

Background: With an increase in recent years in the number of people receiving cosmetic facial injection treatments of hyaluronic acid, the incidence of hyaluronic acid embolism has also increased commensurately. Hyaluronic acid embolism leads to serious complications, including blindness, eye and eyelid movement disorders, skin necrosis, and cerebral embolism. However, there is a lack of robust clinical evidence regarding the benefits of treatment for hyaluronic acid embolism by intraarterial thrombolysis therapy. Methods: This study included 24 patients with a decrease in visual acuity and other complications induced by facial hyaluronic acid injection. Patients underwent emergency intraarterial thrombolysis therapy by injection of hyaluronidase (500 to 1500 units) alone or hyaluronidase (750 to 1500 units) combined with urokinase (100,000 to 250,000 units), followed in both cases by a general symptomatic treatment and nutritional therapy. Results: Ten (42 percent) of 24 patients ultimately had improvements to visual acuity, even when the clinical application of the thrombolytic treatments had passed the recommended window for optimal treatment. In all cases, patients’ facial skin necrosis was restored to nearly normal appearance. In addition, the authors found that hyaluronidase combined with urokinase was a more effective therapy than hyaluronidase alone. Conclusions: The authors’ results indicate that intraarterial thrombolysis therapy is beneficial to patients suffering from blindness induced by hyaluronic acid embolism. The therapy was shown to be worthy of clinical application because it alleviated the impairment to patients’ vision and was also beneficial in the recovery from other serious complications, including eye movement disorder, eye edema, headaches, and skin necrosis. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

The use of periocular fillers in aesthetic medicine

“…A total of 9 cases relating to visual loss following periocular dermal filler injection were identified. 24,[60][61][62][63][64][65][66][67] HA was the most commonly used dermal filler, [61][62][63][64] followed by AF. [65][66][67] CaHA 60 and PLLA 24 were also used.…”

“…65 The glabella area was the most commonly treated area associated with visual loss. [60][61][62]65,66 Ophthalmic artery occlusion was the most commonly documented vascular level of obstruction. 24,61,62,66,67 Hyaluronidase is used in cases of HA-induced obstruction.…”

“…[60][61][62]65,66 Ophthalmic artery occlusion was the most commonly documented vascular level of obstruction. 24,61,62,66,67 Hyaluronidase is used in cases of HA-induced obstruction. [61][62][63][64] The methods of delivery and doses varied with intradermal, 61,64 periocular, 60 retrobulbar, 60 infraorbital 63 supraorbital 63,64 and supratrocheal 64 administration attempted.…”

“…[57][58][59] therapy or oral steroids [57][58][59] Visual Loss 9 cases reports in the literature. 24,[60][61][62][63][64][65][66][67] Hyaluronidase injection is used in cases of HAinduced obstruction. [61][62][63][64] Two case reports of complete restoration of vision.…”

“…24,[60][61][62][63][64][65][66][67] Hyaluronidase injection is used in cases of HAinduced obstruction. [61][62][63][64] Two case reports of complete restoration of vision. 63,64…”