透明质酸注射填充导致眼动脉栓塞的治疗及预防

Treatment and prevention of ophthalmic artery embolization caused by hyaluronic acid cosmetic injections

透明质酸近18年来一直是最常用的面部填充剂,使用量逐年增加,其严重的并发症之一是注射导致的视力损害甚至失明,更令人沮丧的是,这种视力损害迄今为止还缺乏有效的治疗手段。针对透明质酸造成眼动脉栓塞的治疗,球后注射透明质酸酶和血管内介入治疗的有效性和安全性尚存在争议,所以目前业内的共识是预防重于治疗。对于注射所致的视力障碍,其致病机制并未明确,主要有动脉栓塞、动脉缺血、动脉痉挛和静脉累及等理论学说,致病原因主要与眼动脉在面部的分支密切相关,如果能充分掌握这些分支的解剖参数及其在面部的准确分布,则可最大程度地防止透明质酸填充剂进入动脉内。该文对近年来透明质酸注射导致视力缺损的机制、治疗进展和预后进行了分析、总结,有助于增强临床医生对透明质酸注射导致眼动脉栓塞相关解剖学和治疗进展的认识,进一步提高填充剂注射的安全性。

Hyaluronic acid(HA)injections have already been one of most popular cosmetic procedures for around 18 years.However,blindness is one of the most serious complications caused by HA injections.There is still no consensus on the treatment for vision recovery.The efficacy and safety of different delivery administration of hyaluronidase such as retrobulbar injection and endovascular intervention are still controversial so far.Based on current status,prevention is prior to treatment,which is widely recognized in the world.The pathogenic mechanism of blindness induced by filler injection is still not clear,and there exist several theories including the artery embolism,ischaemia,artery spasm and venous involvement,which are all related to the ophthalmic artery and its branches.Therefore,acquiring anatomic knowledge and the relevant parameters will help us prevent to damage the ophthalmic artery and its branches during HA injections.The mechanism,treatment progress and prognosis of blindness caused by HA injections in recent years were analyzed and summarized in this article.We hope it will help the clinician to improve the relevant knowledge about vision loss caused by HA injection,as well as to promote the safety of filler injection.