Department of Ophthalmology of The Third Medical Center of Chinese PLA General Hospital, Beijing, China.
Department of Burns and Plastic Surgery of The Forth Medical Center of Chinese PLA General Hospital, Beijing, China.
J Cosmet Dermatol. 2021 Oct;20(10):3205-3212. doi: 10.1111/jocd.14111. Epub 2021 May 10.
The incidence of hyaluronic acid (HA) embolism has increased markedly in recent years. HA embolism can lead to serious complications such as 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 of HA embolism with intra-arterial thrombolytic therapy (IATT).
In the present study, we enrolled 45 patients with decreased visual acuity, including 40 patients with symptoms of vision loss and eight patients with symptoms of intracranial embolism. The patients underwent emergency IATT via hyaluronidase and papaverine injections, followed by conventional sequential therapy.
In the 45 patients with symptoms of vision loss, 16 (36%) exhibited improvements in final visual acuity, even when the clinical application of the thrombolytic treatments was performed beyond the recommended window for optimal treatment. The facial skin necrosis of all patients was restored to near normal appearance. Notably, for eight patients with suspected symptoms of intracranial infarction we performed cerebral angiography and IATT, and in two patients obtained partial recanalization of the obstruction, the symptoms of heavy headache and binocular distension pain were improved in one patient with intracranial embolism after IATT treatment.
Our results indicate that IATT is feasible for patients with vision loss induced by HA embolism. IATT combined with conventional sequential therapy was beneficial in the recovery from other serious HA embolism complications. Nevertheless, the underlying pathophysiological mechanism needs to be clarified in future animal experiments.
近年来，透明质酸（HA）栓塞的发病率显著增加。HA 栓塞可导致严重并发症，如失明、眼部和眼睑运动障碍、皮肤坏死和脑栓塞。然而，关于动脉内溶栓治疗（IATT）治疗 HA 栓塞的益处，缺乏强有力的临床证据。
本研究纳入了 45 例视力下降患者，包括 40 例视力丧失症状患者和 8 例颅内栓塞症状患者。患者接受透明质酸酶和罂粟碱注射的紧急 IATT，然后进行常规序贯治疗。
在 45 例有视力丧失症状的患者中，16 例（36%）的最终视力有所改善，即使溶栓治疗的临床应用超出了最佳治疗的推荐时间窗。所有患者的面部皮肤坏死均恢复到接近正常的外观。值得注意的是，对于 8 例疑似颅内梗死症状的患者，我们进行了脑血管造影和 IATT，其中 2 例阻塞部分再通，1 例颅内栓塞患者 IATT 治疗后头痛和双眼肿胀疼痛症状改善。
我们的结果表明，IATT 对 HA 栓塞引起的视力丧失患者是可行的。IATT 联合常规序贯治疗有利于从其他严重的 HA 栓塞并发症中恢复。然而，其潜在的病理生理机制需要在未来的动物实验中阐明。
