Zhang Lei, Pan Lei, Xu Hong, Yan Sheng, Sun Yi, Wu Woffles T L, Wu Sufan
Department of Plastic and Reconstructive Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, China.
Woffles Wu Aesthetic Surgery, Camden Medical Centre, 1 Orchard Boulevard, Suite 09-02, Singapore, 248649, Singapore.
Aesthetic Plast Surg. 2019 Aug;43(4):1054-1060. doi: 10.1007/s00266-019-01374-w. Epub 2019 Apr 21.
Blindness or visual loss is the most serious complication resulting from facial hyaluronic acid (HA) injection. In this study, three recent clinical cases were analyzed, and the relevant anatomy of cadavers was evaluated to investigate the mechanism behind visual impairment due to HA injection.
Three patients with different extents of visual loss after HA injection were studied. Ophthalmic testing and corresponding treatments were performed, and the clinical progress was observed. In addition, thirty-six fresh Asian cadaver hemifaces were anatomized to investigate the morphology of the ophthalmic artery and its branches. The minimum dose of HA for central retinal artery embolism was calculated based on the ophthalmic arterial volumes of cadavers.
Visual impairment was more severe in central retinal artery occlusion and combined intraocular branch occlusion than in posterior ciliary artery occlusion. During follow-up, no improvement was observed in terms of visual impairment. Cadaver study reconfirmed that the ophthalmic artery included facial and intraocular branches. The ophthalmic arterial volumes running from the supraorbital artery and supratrochlear artery to the central retinal artery were 0.083 cm and 0.089 cm, respectively.
The severity of blindness caused by HA injection may be associated with the occlusion site. Our clinical observations indicate that conventional treatments, such as retrobulbar hyaluronidase injection, are insufficient to relieve visual impairment. Injecting as little as 0.08 ml of HA into the facial branch is enough to cause central retinal artery embolism. Limiting the volume per injection could represent a simple prophylactic strategy.
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失明或视力丧失是面部注射透明质酸（HA）导致的最严重并发症。本研究分析了三例近期临床病例，并评估了尸体的相关解剖结构，以探究HA注射导致视力损害的机制。
研究了三例HA注射后出现不同程度视力丧失的患者。进行了眼科检查及相应治疗，并观察临床进展。此外，解剖了36个新鲜的亚洲人尸体半侧面部，以研究眼动脉及其分支的形态。根据尸体的眼动脉容量计算视网膜中央动脉栓塞的最小HA剂量。
视网膜中央动脉阻塞和合并眼内分支阻塞导致的视力损害比睫状后动脉阻塞更严重。随访期间，视力损害未见改善。尸体研究再次证实眼动脉包括面部和眼内分支。从眶上动脉和滑车上动脉至视网膜中央动脉的眼动脉容量分别为0.083 cm和0.089 cm。
HA注射导致失明的严重程度可能与阻塞部位有关。我们的临床观察表明，传统治疗方法，如球后注射透明质酸酶，不足以缓解视力损害。向面部分支注射低至0.08 ml的HA就足以导致视网膜中央动脉栓塞。限制每次注射量可能是一种简单的预防策略。
证据等级V：本刊要求作者为每篇文章指定一个证据等级。有关这些循证医学评级的完整描述，请参阅目录或作者在线指南www.springer.com/00266 。
