超选择性眼动脉介入溶栓成功救治透明质酸隆鼻致单眼失明一例报告及文献回顾

Successful rescue of monocular blindness induced by hyaluronic acid rhinoplasty using super-selective intra-arterial thrombolytic therapy of the ophthalmic artery:Case report and literature review

目的报道1例采用超选择性眼动脉介入溶栓治疗(intra-artery thrombolytic therapy,IAT)方式成功救治透明质酸(hyaluronic acid,HA)填充隆鼻致右眼失明的案例,并结合文献探究超选择性眼动脉IAT救治HA致眼动脉栓塞的特点、安全性和疗效。方法2023年7月,青岛市第八人民医院对1例HA导致视网膜中央动脉栓塞致盲的患者,采用超选择性眼动脉IAT救治成功,患者恢复正常视力。并分别以注射美容、透明质酸、视力受损、失明、玻璃酸酶或透明质酸酶、动脉内溶栓治疗或介入溶栓和filler injection,hyaluronic acid(HA),soft tissue augmentation,blindness OR ophthalmoplegia,visual impairment OR retinal artery occlusion OR ophthalmic artery occlusion,Hyaluronidase,intra-arterial thrombolytictherapy为关键词检索数据库进行搜索,时限为2010年1月至2023年7月。统计内容包括研究者、患者、并发症、治疗方法和结果。结果共纳入10篇文献,分别来自中国(6篇)及韩国(4篇);纳入114例患者(含本案1例)。所有患者均出现视力受损,甚至失明;均接受了超选择性眼动脉IAT溶栓,溶栓药物为玻璃酸酶(93例)、尿激酶(1例)或两者联合应用(17例),最佳使用量、稀释浓度和治疗时长目前并无统一方案;对视力改善的患者首次超选择性眼动脉IAT治疗时间、就诊前视力情况及视力改善结果分析,其视力改善情况与首次超选择性眼动脉IAT是否于时间窗内相关不显著(P>0.05),与超选择性眼动脉IAT时患者视力受损程度显著相关(P<0.05)。结论超选择性眼动脉IAT释放玻璃酸酶及尿激酶治疗,能再通HA面部填充引起的眼动脉及分支栓塞,恢复血流,改善受损视力,但效果有限。超选择性眼动脉IAT作为HA相关动脉内栓塞溶栓的有效治疗方法,仍值得积极尝试。

Objective To report a case of successful rescue of right eye blindness induced by hyaluronic acid(HA)filler rhinoplasty using super-selective intra-artery thrombolytic therapy(IAT)of the ophthalmic artery,and explore the characteristics,safety,and efficacy 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 embolismdue 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 ophthalmoplegia,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 complication 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 IATof 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 concentration,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 ophthalmic artery and its branches that have been embolized due to HA facial fillers,thereby restoring blood flowand improving impaired vision.However,the effect is limited.As an effective treatment for thrombolysis of HA-related intra-arterial embolism,super-selective ophthalmic artery IAT is still worth actively trying.