Exploring Superselective Intraarterial Thrombolysis for Autologous Fat Injection–Induced Vision Loss

Abstract

Background Intra-vascular injection represents the most severe complication in fat transplantation procedures. Currently, the prognosis for patients who suffer from blindness due to fat transplantation-induced ocular vascular occlusion is far from optimistic. Objectives Exploring and evaluating the efficacy and safety of arterial thrombolysis in the treatment of ocular vascular occlusion caused by fat transplantation. Methods We analyzed the data of 12 patients who underwent intra-arterial thrombolysis and conservative treatments for facial autologous fat grafting-associated ocular vascular occlusion. Among the cases, there were 6 instances of ophthalmic artery embolism and 6 cases of central retinal artery occlusion. All patients suffered with sudden blindness, may accompanied by eye pain, ptosis, and strabismus, skin necrosis at the injection site, and cerebral microinfarction. They received symptomatic conservative treatments and intra-arterial thrombolysis, encompassing mechanical vessel recanalization, vessel dilation, and dissolution of thrombus constituents. Results Following intra-arterial thrombolysis, a noteworthy improvement in the blood flow of both the main trunk and peripheral branches of the ophthalmic artery was observed in the majority of patients when contrasted with their pre-treatment status. One patient experienced a headache intraoperatively, while no significant discomfort was reported by the remaining patients. After conservative treatments and intra-arterial thrombolysis, all patients experienced improvement in ocular symptoms, skin necrosis and cerebral infarction. Three patients demonstrated improvement in visual acuity. These patients have surpassed the recommended time window for treatment, yet the occlusion of the ophthalmic artery is not complete. Conclusions Intra-arterial thrombolysis combined with conservative treatments achieves early perfusion and is expected to promote visual recovery. Hospitals that possess the necessary treatment capabilities are encouraged to establish this therapeutic pathway.