Cohen Liza M, Ponce Mejia L Luciano, Duckwiler Gary R, Goldberg Robert A, Rootman Daniel B
Division of Orbital and Ophthalmic Plastic Surgery, Stein Eye Institute, University of California, Los Angeles, CA, USA.
Division of Interventional Neuroradiology, Department of Radiology, University of California, Los Angeles, CA, USA.
Orbit. 2023 Oct;42(5):529-535. doi: 10.1080/01676830.2022.2149818. Epub 2022 Dec 5.
One of the most devastating complications of facial filler injection is sudden ischemic blindness. However, its mechanisms and predisposing factors are poorly understood. The purpose of this study was to investigate the prevalence of external carotid artery (ECA) to ophthalmic artery (OA) anterograde flow in patients with internal carotid artery (ICA) stenosis and in a control population without carotid disease.
In this cross-sectional cohort study, two groups of patients who underwent catheter cerebral angiography over a 5-year period were identified: patients with symptomatic ICA stenosis and a control group of patients with refractory epistaxis undergoing embolization. Angiograms were reviewed by an interventional neuroradiologist. The primary outcome measure was the presence of ECA to OA flow, defined as choroidal blush before filling of the circle of Willis. Secondary outcome measures included the percentage and location of ICA stenosis and ECA anastomotic branches involved.
The study included 149 patients with ICA stenosis and 69 control patients. ECA to OA flow was more prevalent in patients with ICA stenosis (34.9%) compared to controls (2.9%) ( < .001). Logistic regression demonstrated that for each 10% increase in ICA stenosis over 70%, there was 2.8 times increased risk of ECA to OA flow ( < .001).
ECA to ICA anterograde flow can be demonstrated in approximately 3% of control patients and in over 1/3 of patients with symptomatic carotid stenosis. This provides a plausible pathway for small filler particles to pass with blood flow from the facial to the ophthalmic circulation.
面部填充剂注射最严重的并发症之一是突然缺血性失明。然而，其机制和易感因素尚不清楚。本研究的目的是调查颈内动脉（ICA）狭窄患者和无颈动脉疾病的对照人群中外颈动脉（ECA）至眼动脉（OA）顺行血流的发生率。
在这项横断面队列研究中，确定了两组在5年期间接受导管脑血管造影的患者：有症状的ICA狭窄患者和接受栓塞治疗的难治性鼻出血对照组患者。血管造影由介入神经放射科医生进行评估。主要观察指标是ECA至OA血流的存在，定义为Willis环充盈前的脉络膜潮红。次要观察指标包括ICA狭窄的百分比和位置以及涉及的ECA吻合支。
该研究纳入了149例ICA狭窄患者和69例对照患者。与对照组（2.9%）相比，ICA狭窄患者中ECA至OA血流更为常见（34.9%）（P<0.001）。逻辑回归分析表明，ICA狭窄超过70%每增加10%，ECA至OA血流的风险增加2.8倍（P<0.001）。
在大约3%的对照患者和超过1/3的有症状颈动脉狭窄患者中可显示ECA至ICA的顺行血流。这为小的填充颗粒随血流从面部循环进入眼循环提供了一条合理的途径。
