EverKeen Medical Centre, Hong Kong.
The Skin Oracle, Hong Kong.
J Dermatolog Treat. 2024 Dec;35(1):2402909. doi: 10.1080/09546634.2024.2402909. Epub 2024 Sep 12.
Dermal fillers are widely used for facial rejuvenation and esthetic enhancement, offering temporary solutions for aging and volume loss. Despite their general safety, a rare but severe complication associated with these fillers is visual impairment, including blindness. This underscores the need for a thorough understanding of risks associated with various filler materials. Historical cases of blindness following filler injections date back to 1963, with increasing reports linked to the expansion of the cosmetic filler industry. While hyaluronic acid (HA) and autologous fat have been extensively studied, other fillers such as calcium hydroxylapatite and poly-l-lactic acid (PLLA) are less understood.
This systematic review aims to address gaps in the literature by providing a comprehensive overview of visual impairment caused by fillers other than HA and autologous fat. We systematically examine the prevalence, causes, clinical features, and treatment outcomes associated with these less common fillers.
A comprehensive literature search was conducted across databases including PubMed, Scopus, and Google Scholar using terms related to visual impairment and dermal fillers. Studies published between 2014 and 2021, including observational studies and case reports, were included. Studies were selected based on predefined inclusion and exclusion criteria, and a PRISMA flow diagram was used to illustrate the study selection process.
The review identifies and summarizes cases of visual impairment associated with calcium hydroxylapatite, poly-d,l-lactic acid (PDLLA), and PLLA fillers. Key findings reveal that visual impairment following these fillers is rare but can occur suddenly or within a few days of the procedure. Cases of delayed onset up to two weeks are also noted, emphasizing the need for extended post-procedure monitoring.
The review highlights unique insights into the risks associated with non-HA fillers, such as the heightened risk in the periorbital region and other facial areas. It explores mechanisms of complications, including retrograde flow of emboli leading to retinal ischemia. The discussion also covers emergency protocols and preventative measures, providing valuable guidance for managing and mitigating risks.
Visual impairment caused by fillers other than HA and autologous fat, while rare, represents a serious complication that requires careful attention. This review contributes new perspectives on the differential risks of various fillers, symptom onset variability, and anatomical risk factors. Emphasizing the importance of proper patient selection, technique, and monitoring, it calls for further research to better understand and prevent these complications, ultimately aiming for safer and more effective use of soft-tissue fillers.
真皮填充剂广泛用于面部年轻化和美容增强，为衰老和体积丧失提供暂时的解决方案。尽管它们通常是安全的，但与这些填充物相关的一种罕见但严重的并发症是视力障碍，包括失明。这突显出需要全面了解各种填充物材料相关的风险。自 1963 年以来，已有历史病例报告称在填充物注射后出现失明，与整容填充物行业的扩张相关的报告越来越多。虽然透明质酸 (HA) 和自体脂肪已被广泛研究，但其他填充物，如钙羟基磷灰石和聚左旋乳酸 (PLLA) 的了解较少。
本系统综述旨在通过全面概述除 HA 和自体脂肪以外的填充物引起的视力障碍来填补文献中的空白。我们系统地检查了这些不太常见的填充物相关的患病率、原因、临床特征和治疗结果。
通过使用与视力障碍和真皮填充物相关的术语，对包括 PubMed、Scopus 和 Google Scholar 在内的数据库进行了全面的文献检索。纳入了 2014 年至 2021 年期间发表的观察性研究和病例报告。根据预先确定的纳入和排除标准选择研究，并使用 PRISMA 流程图说明研究选择过程。
该综述确定并总结了与钙羟基磷灰石、聚-d,l-乳酸 (PDLLA) 和 PLLA 填充物相关的视力障碍病例。主要发现表明，这些填充物引起的视力障碍虽然罕见，但可能在手术后几天内突然发生或发生。也有报道称延迟至两周，这强调了需要进行更长时间的术后监测。
该综述强调了与非 HA 填充物相关的风险的独特见解，例如在眶周区域和其他面部区域的风险增加。它探讨了并发症的机制，包括栓塞物逆行流动导致视网膜缺血。讨论还包括紧急协议和预防措施，为管理和降低风险提供了有价值的指导。
除 HA 和自体脂肪以外的填充物引起的视力障碍虽然罕见，但代表了一种严重的并发症，需要引起重视。本综述提供了关于各种填充物的不同风险、症状发作变异性和解剖风险因素的新观点。强调了正确选择患者、技术和监测的重要性，呼吁进一步研究以更好地理解和预防这些并发症，最终目标是更安全、更有效地使用软组织填充物。
