Successful rescue of monocular blindness induced by hyaluronic acid rhinoplasty using super-selective intra-arterial throm-bolytic therapy of the ophthalmic artery:Case report and literature review
LI Kun
SUN Hui
GUAN Xiaoyu
YANG Qiao
HU Xiaoying
HE Xiliang
Abstract：Objective To report a case of successful rescue of right eye blindness induced by hyaluronic acid(HA)filler rhino-plasty using super-selective intra-artery thrombolytic therapy(IAT)of the ophthalmic artery,and explore the characteristics,safety,and ef-ficacy of super-selective ophthalmic artery IAT in treating ophthalmic artery embolism caused by HA through a review of the literature.Methods In July 2023,Qingdao Eighth People's Hospital successfully treated a case of blindness caused by central retinal artery em-bolism due to HA with super-selective IAT of the ophthalmic artery,and the patient's vision returned to normal.A search was conducted in the database using the following keywords:cosmetic filler injection,hyaluronic acid(HA),soft tissue augmentation,blindness OR ophthal-moplegia,visual impairment OR retinal artery occlusion OR ophthalmic artery occlusion,hyaluronidase,intra-arterial thrombolytic therapy.The time limit for the search was from January 2010 to July 2023.The statistics included researchers,patient conditions,patient complica-tion information,treatment information,and treatment outcomes.Results A total of 10 studies were included,with 6 from Chinese teams and 4 from Korean teams.These studies encompassed 114 patients including 1 case from the present study.All patients experienced vision loss or even blindness and received super-selective IAT of the ophthalmic artery.The thrombolytic agents used were hyaluronidase(93 cases)or urokinase(1 case),or a combination of both(17 cases).Currently,there is no unified protocol for the optimal dosage,dilution concentra-tion,and treatment duration.When analysing the time of the first super-selective ophthalmic artery IAT treatment,the visual acuity before consultation,and the results of visual acuity improvement for patients with improved vision,it was found that the visual acuity improvement was not significantly correlated with whether or not the first super-selective ophthalmic artery IAT was performed within the time window(P＞0.05),but significantly correlated with the extent of the patients'impaired visual acuity at the time of the super-selective ophthalmic artery IAT(P＜0.05).Conclusion Super-selective IAT of the ophthalmic artery,using hyaluronidase and urokinase,can recanalize oph-thalmic artery and its branches that have been embolized due to HA facial fillers,thereby restoring blood flow and improving impaired vi-sion.However,the effect is limited.As an effective treatment for thrombolysis of HA-related intra-arterial embolism,super-selective oph-thalmic artery IAT is still worth actively trying.
Keywords：Super-selective intra-artery thrombolytic therapy of the ophthalmic arteryArterial thrombolysisHyaluronic acidHyaluronidaseBlindness
Publication Date：2024-09-15
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：6( 552-556,565 )