头面部美容填充物致眼动脉及其分支动脉阻塞的临床特征和视力预后影响因素分析

Clinical Characteristics and Factors Related to Visual Prognosis of Ophthalmic Artery and its Branch Occlusion Caused by Cosmetic Facial Filler Injection

目的总结头面部美容填充物注射引起的眼动脉及其分支动脉阻塞的临床特征和视力预后影响因素。方法本研究为回顾性病例研究。共纳入头面部美容填充物注射后立即出现视力下降、视物重影或上睑下垂等眼科症状的患者26例,收集并分析所有患者的临床和影像学资料。结果26例患者中,注射透明质酸者23例,注射自体脂肪者2例,注射干细胞制剂者1例。注射点位于额部8例、额部+眉间4例、眉间3例、眉间+鼻根1例、鼻根4例、鼻翼1例、眼睑4例、颞侧头皮1例。临床表现:眼动脉阻塞2例,视网膜中央动脉阻塞(central retinal artery occlusion,CRAO)7例(其中不完全性CRAO 1例),睫状后短动脉阻塞12例[其中非动脉炎性前部缺血性视神经病变(non-arteritic anterior ischemic optic neuropathy,NAION)6例、非动脉炎性后部缺血性视神经病变3例、局限性脉络膜水肿3例],眼外肌麻痹5例(其中眼动脉肌支阻塞4例,动眼神经麻痹1例),上睑下垂4例,瞳孔散大2例。其中6例患者同时发生2种眼部受累表现,包括CRAO+局限性脉络膜水肿2例,NAION+局限性脉络膜水肿1例,NAION+肌支阻塞1例,NAION+动眼神经麻痹1例,上睑下垂+肌支阻塞1例。头颅MRI检查显示新发性脑梗死灶3例。18例视网膜或视神经受累患者中,11例患者表现为完全性CRAO或弥漫性视神经缺血,治疗前后患者视力无改变;7例患者表现为不完全性CRAO或节段性视神经缺血,治疗后患者视力有明显改善。结论头面部美容填充物注射引起的眼动脉及其分支动脉阻塞视力预后差,不完全性CRAO、节段性视神经缺血和初诊时最佳矫正视力≥0.02的患者视力预后较好。

Objective To evaluate the clinical characteristics and factors related to visual prognosis of ophthalmic artery and its branch occlusion caused by cosmetic facial filler injection.Methods In this retrospective case study,a total of 26 patients with ophthalmic symptoms including visual loss,diplopia,or ptosis immediately after cosmetic facial filler injection were included.Clinical and imaging data of all patients were collected and analyzed.Results Among 26 patients,hyaluronic acid,autologous fat,and stem cell preparation was injected in 23,2,and 1 case,respectively.Injection point was located in the forehead,forehead combined with glabella,glabella,glabella combined with nasal root,nasal root,nasal ala,eyelid,and temporal scalp in 8,4,3,1,4,1,4,and 1 case,respectively.Clinical manifestations included ophthalmic artery occlusion(2 cases),central retinal artery occlusion(CRAO)(7 cases,including one case of incomplete CRAO),posterior ciliary short artery occlusion[12 cases,including 6 cases of non-arteritic anterior ischemic optic neuropathy(NAION),3 cases of non-arteritic posterior ischemic optic neuropathy,and 3 cases of focal choroidal ischemia],external ophthalmoplegia(5 cases,including 4 cases of ophthalmic artery muscular branch occlusion,and one case of oculomotor nerve palsy),ptosis(4 cases),and mydriasis(2 cases).Among them,6 patients had two ocular involvement manifestations at the same time,including CRAO+focal choroidal ischemia in 2 cases,NAION+focal choroidal ischemia in 1 case,NAION+muscular branch occlusion in 1 case,NAION+oculomotor nerve palsy in 1 case,ptosis+muscular branch occlusion in 1 case.Cranial MRI examination revealed new focal cerebral infarctions in 3 cases.Among 18 patients with retinal or optic nerve involvement,11 cases showed complete CRAO or diffuse ischemic optic neuropathy,and no visual improvement after treatment;7 patients showed incomplete CRAO or segmental ischemic optic neuropathy,and evident visual improvement after treatment.Conclusions Visual prognosis of ophthalmic artery and its branch occlusion caused by cosmetic facial filler injection is poor.Incomplete CRAO,segmental ischemic optic neuropathy,and best corrected visual acuity≥0.02 at baseline are main factors indicating a relatively good visual prognosis.