Skippen Brent, Baldelli Ilaria, Hartstein Morris, Casabona Gabriela, Montes Jose Raul, Bernardini Francesco
Oculoplastic surgeon in private practice in Wagga Wagga, Australia.
Department of Plastic Surgery, University of Genova, San Martino Hospital, Genova, Italy.
Aesthet Surg J. 2020 Jan 29;40(2):197-205. doi: 10.1093/asj/sjz078.
Chronic, long-lasting edema accompanied by the Tyndall effect as a delayed reaction to hyaluronic acid (HA) filler injection seems to occur exclusively in the eyelids.
The authors sought to present a treatment algorithm for management of patients with chronic lower eyelid edema as a delayed complication of HA filler injection.
Retrospective study including 61 patients with delayed-onset chronic periocular edema following uneventful HA filler injection in the lower eyelids or cheeks. All patients underwent hyaluronidase enzyme dissolution followed by secondary treatment. Three retreatment options were presented: (1) observation, (2) secondary treatment with HA filler, and (3) lower eyelid blepharoplasty.
All patients underwent filler dissolution using hyaluronidase. The mean age was 48 years and 97% of the patients were female. Single treatment was effective in 92% of patients with 8% requiring another hyaluronidase injection to completely eradicate residual edema. Six patients (10%) were satisfied after hyaluronidase only and 6 patients (10%) underwent lower eyelid blepharoplasty. Secondary treatment with HA filler was performed in 48 patients (80%). All were satisfied with final results without further edema in the follow-up period.
Delayed-onset chronic lower eyelid edema is a frequent HA-related complication and cause of concern when considering periocular HA treatment. Previous treatment has been limited to either hyaluronidase only or blepharoplasty as a secondary solution after hyaluronidase, with only a minority of patients satisfied. Hyaluronidase, shortly followed by HA filler retreatment, is a safe and effective solution.
慢性、持久的水肿伴有廷德尔效应，作为透明质酸（HA）填充剂注射的延迟反应，似乎仅发生在眼睑。
作者旨在提出一种治疗算法，用于管理慢性下睑水肿患者，该水肿是HA填充剂注射的延迟并发症。
回顾性研究包括61例在下眼睑或脸颊进行HA填充剂注射后出现延迟性慢性眼周水肿的患者。所有患者均接受了透明质酸酶溶解，随后进行二次治疗。提出了三种再治疗方案：（1）观察，（2）用HA填充剂进行二次治疗，（3）下睑成形术。
所有患者均使用透明质酸酶进行填充剂溶解。平均年龄为48岁，97%的患者为女性。单次治疗对92%的患者有效，8%的患者需要再次注射透明质酸酶以完全消除残留水肿。6例患者（10%）仅接受透明质酸酶治疗后感到满意，6例患者（10%）接受了下睑成形术。48例患者（80%）接受了HA填充剂二次治疗。所有患者对最终结果均满意，随访期间无进一步水肿。
延迟性慢性下睑水肿是一种常见的与HA相关的并发症，在考虑眼周HA治疗时令人担忧。以往的治疗仅限于单独使用透明质酸酶或在透明质酸酶治疗后进行成形术作为二次解决方案，只有少数患者感到满意。透明质酸酶治疗后不久进行HA填充剂再治疗是一种安全有效的解决方案。
