颜面部美容注射引发眼部并发症解剖分析

Analysis of ocular complications caused by injection of facial cosmetic

目的分析颜面部美容注射后引发视网膜中央动脉阻塞或眼动脉阻塞的颜面部血管吻合解剖学特点。方法回顾性分析2010年6月至2015年6月3例因额面部美容后出现视力急剧下降,经眼底检查、荧光素视网膜血管造影检查确诊为视网膜中央动脉阻塞的患者,分析注射部位血管分布及眶周血管吻合特点。结果 3例患眼均无光感并伴有眼痛或(及)眼球转动痛,视网膜血管造影均表现为完全性中央动脉阻塞;面部美容注射压在开始注射2 s后就大大超过眼动脉收缩压(P<0.05);鼻背动脉与内眦动脉多有吻合,内眦动脉常与后睫状长动脉的鼻侧分支吻合。填充物进入上述血管后可经吻合动脉分支进入眼动脉,使得填充物阻塞与眼动脉、视网膜中央动脉、睫状后短动脉及其分支内。结论颜面部美容注射时,注射物可能会进入眶周围动脉,逆行流入眼动脉,造成眼动脉阻塞,或经眼动脉流入视网膜中央动脉、睫状动脉,从而造成严重的眼部并发症。

Objective To analyze the anatomic factors of the central retinal artery occlusion or the ophthalmic artery occlusion after the injection of facial cosmetic surgery.Methods Retrospectively analyzed 3 patients who occurred severely ocular complications just after facial cosmetic injection in last 2 years.The diagnosis of central retinal artery occlusion was confirmed by fundus examination and fundus fluoresce-in angiography.Analysis the blood vessel distribution of the injection site and characteristics of peri-orbit vascular anastomosis.Results All the 3 cases presented no light perception,with eye pain or （and）the eyeball pain.The fundus test and fundus fluorescein angiographies showed central retinal artery obstruction.Facial cosmetic injection pressure significantly exceeded the ophthalmic artery systolic pressure 2 seconds after injection （P 〈0.05）.Dorsal nasal artery and angular artery were anastomotic,and the angular artery was usually anastomotic with lateral nasal branches of the posterior ciliary artery.The filler can enter the ophthalmic artery by the branches of the anastomosis,which can make ophthalmic artery occlusion,central retinal artery occlusion or get occlusion of their branches.Conclusion The injectant may get into the orbital artery and retrograde to the ophthalmic artery,which resulting in ophthalmic artery occlusion,or get into central retinal artery and posterior ciliary artery,which resulting in serious ocular complications.