70401 Department of Surgery, Cumming School of Medicine, University of Calgary, Alberta, Canada.
Department of Surgery, Division of Ophthalmology, Cumming School of Medicine, University of Calgary, Alberta, Canada.
J Cutan Med Surg. 2021 Sep;25(5):543-552. doi: 10.1177/1203475421999340. Epub 2021 Mar 2.
In the past few decades, minimally-invasive esthetic treatments and the use of injectable Hyaluronic Acid Gels and other filling agents to treat facial esthetics have increased dramatically. Although extremely rare, a filler can cause ocular and orbital ischemia by retrograde flow from the ophthalmic artery when injected in any of the anastomosis of the face. Once filler reaches the central retinal artery, blindness is inevitable, and no treatment is effective. While the risk of blindness happening with any filler injection is rare, the life-altering irreversible consequence of a procedure that was anticipated to be simple and beautifying is a reality that each injector must be prepared for with every injection. The parameters associated with an iatrogenic stroke of the eye are the site of injection, the injection technique, patient characteristics, and the material injected. Understanding the interplay of each of these variables might help us reduce the possibility of blindness during the injection of a soft-tissue cosmetic filler. Here, we explore the causes of Hyaluronic Acid Gels Filler embolic phenomena, review the natural course of the process, and discuss appropriate immediate interventions. We also (1) propose an education plan for injectors and describe how to carry out a focused ophthalmologic examination and procedural activities for a referral to an ophthalmologist, (2) outline steps to prevent emboli during filler injection, and (3) how to manage and support a patient with a sudden loss of vision during or immediately after a Hyaluronic Acid Gels filler treatment.
在过去的几十年中，微创美容治疗以及使用可注射透明质酸凝胶和其他填充剂来治疗面部美学问题的方法已经有了显著的发展。虽然极为罕见，但当填充物在面部的任何吻合处注入时，都可能通过眼动脉逆行流动而导致眼部和眶内缺血。一旦填充物到达视网膜中央动脉，失明将是不可避免的，而且没有任何治疗方法有效。虽然任何填充物注射引起失明的风险都很低，但原本预计简单而美化的手术会带来改变生活且无法逆转的后果，这是每个注射者在进行每次注射时都必须做好准备的现实。与眼部医源性中风相关的参数包括注射部位、注射技术、患者特征和注射材料。了解这些变量的相互作用可能有助于我们降低在注射软组织美容填充物期间失明的可能性。在这里，我们探讨了透明质酸凝胶填充物栓塞现象的原因，回顾了该过程的自然病程，并讨论了适当的即刻干预措施。我们还（1）为注射者提出了一个教育计划，并描述了如何进行有针对性的眼科检查和程序活动以转介给眼科医生，（2）概述了在填充剂注射过程中预防栓塞的步骤，以及（3）如何管理和支持在透明质酸凝胶填充剂治疗期间或之后立即出现视力丧失的患者。
