Department of Ophthalmology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Floor 11, Building 19, 1665 Kongjiang Rd., Shanghai, 200092, China.
Ruijin Hospital Affiliated Shanghai Jiaotong University School of Medicine, Shanghai, China.
Aesthetic Plast Surg. 2024 Feb;48(4):709-718. doi: 10.1007/s00266-022-03215-9. Epub 2022 Dec 27.
With the global increase in the use of injectable fillers, more cases with serious adverse events such vision loss are being reported. This article aims to review the cases of hyaluronic acid (HA) filler-related vision loss and to discuss the potential efficacy of hyaluronidase (HYASE) treatment via different given methods.
A total of 29 articles presenting 144 cases of HA filler-related vision loss were included in this study.
Most cases of HA filler-related vision impairment were reported from China, followed by Korea. The majority of cases were seen in women. The nose, forehead and glabella were the most commonly injection sites. All cases had vision impairment and nearly all cases were unilateral with immediate onset of visual signs and symptoms. Ophthalmic artery occlusion (OAO) and central retinal artery occlusion (CRAO) were the two most commonly involved arterial obstruction patterns featured with a very poor prognosis followed by branch retinal artery occlusion (BRAO), the most favorable involved arterial pattern for a better prognosis. HYASE given subcutaneously and intra-arterially helped with visual recovery to different degrees, while retrobulbar HYASE seemed to be less helpful.
Complications after HA-based filler injection are extremely rare but can cause disastrous visual impairment. HYASE given subcutaneously and intra-arterially helped with visual recovery to different extents, and the efficacy might be reinforced when performed together, while retrobulbar HYASE seemed to be less helpful. However, to accurately access the efficacy of HYASE via different administration methods, further randomized controlled trials are needed.
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
随着全球范围内注射用填充剂的使用增加，越来越多的严重不良事件（如视力丧失）的病例被报道。本文旨在回顾透明质酸（HA）填充剂相关视力丧失的病例，并讨论通过不同给药方法使用透明质酸酶（HYASE）治疗的潜在疗效。
共有 29 篇文章报道了 144 例 HA 填充剂相关视力丧失的病例，本研究纳入了这些文章。
HA 填充剂相关视力损害病例主要来自中国，其次是韩国。大多数病例发生在女性中。鼻子、额头和眉间是最常见的注射部位。所有病例均有视力障碍，几乎所有病例均为单侧，视力障碍的视觉症状和体征立即出现。眼动脉阻塞（OAO）和视网膜中央动脉阻塞（CRAO）是最常见的动脉阻塞模式，预后极差，其次是视网膜分支动脉阻塞（BRAO），这是一种预后较好的最常见的动脉阻塞模式。皮下和动脉内给予 HYASE 有助于不同程度的视力恢复，而球后 HYASE 似乎效果较差。
HA 基填充剂注射后的并发症极为罕见，但可导致灾难性的视力损害。皮下和动脉内给予 HYASE 有助于不同程度的视力恢复，联合使用可能会增强疗效，而球后 HYASE 似乎效果较差。然而，要准确评估不同给药方法的 HYASE 疗效，需要进一步的随机对照试验。
证据水平 III：本杂志要求作者为每篇文章分配一个证据水平。有关这些循证医学评级的完整描述，请参考目录或在线作者指南 www.springer.com/00266 。
