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Cerebral Angiographic Findings of Cosmetic Facial Filler-related Ophthalmic and Retinal Artery Occlusion.

Abstract

Cosmetic facial filler-related ophthalmic artery occlusion is rare but is a devastating complication, while the exact pathophysiology is still elusive. Cerebral angiography provides more detailed information on blood flow of ophthalmic artery as well as surrounding orbital area which cannot be covered by fundus fluorescein angiography. This study aimed to evaluate cerebral angiographic features of cosmetic facial filler-related ophthalmic artery occlusion patients. We retrospectively reviewed cerebral angiography of 7 patients (4 hyaluronic acid [HA] and 3 autologous fat-injected cases) showing ophthalmic artery and its branches occlusion after cosmetic facial filler injections, and underwent intra-arterial thrombolysis. On selective ophthalmic artery angiograms, all fat-injected patients showed a large filling defect on the proximal ophthalmic artery, whereas the HA-injected patients showed occlusion of the distal branches of the ophthalmic artery. Three HA-injected patients revealed diminished distal runoff of the internal maxillary and facial arteries, which clinically corresponded with skin necrosis. However, all fat-injected patients and one HA-injected patient who were immediately treated with subcutaneous hyaluronidase injection showed preserved distal runoff of the internal maxillary and facial arteries and mild skin problems. The size difference between injected materials seems to be associated with different angiographic findings. Autologous fat is more prone to obstruct proximal part of ophthalmic artery, whereas HA obstructs distal branches. In addition, hydrophilic and volume-expansion property of HA might exacerbate blood flow on injected area, which is also related to skin necrosis. Intra-arterial thrombolysis has a limited role in reconstituting blood flow or regaining vision in cosmetic facial filler-associated ophthalmic artery occlusions.

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  • Authors+Show Affiliations

    ,

    Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea. ; Department of Ophthalmology, Hallym University College of Medicine, Kangdong Sacred Heart Hospital, Seoul, Korea.

    ,

    Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.

    ,

    Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.

    Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.

    Source

    Journal of Korean medical science 30:12 2015 Dec pg 1847-55

    MeSH

    Adipose Tissue
    Adult
    Aged
    Arterial Occlusive Diseases
    Cerebral Angiography
    Cosmetic Techniques
    Dermal Fillers
    Face
    Female
    Humans
    Hyaluronic Acid
    Hyaluronoglucosaminidase
    Injections, Subcutaneous
    Ophthalmic Artery
    Retinal Artery Occlusion
    Retrospective Studies
    Transplantation, Autologous
    Young Adult

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    26713062

    Citation

    Kim, Yong-Kyu, et al. "Cerebral Angiographic Findings of Cosmetic Facial Filler-related Ophthalmic and Retinal Artery Occlusion." Journal of Korean Medical Science, vol. 30, no. 12, 2015, pp. 1847-55.
    Kim YK, Jung C, Woo SJ, et al. Cerebral Angiographic Findings of Cosmetic Facial Filler-related Ophthalmic and Retinal Artery Occlusion. J Korean Med Sci. 2015;30(12):1847-55.
    Kim, Y. K., Jung, C., Woo, S. J., & Park, K. H. (2015). Cerebral Angiographic Findings of Cosmetic Facial Filler-related Ophthalmic and Retinal Artery Occlusion. Journal of Korean Medical Science, 30(12), pp. 1847-55. doi:10.3346/jkms.2015.30.12.1847.
    Kim YK, et al. Cerebral Angiographic Findings of Cosmetic Facial Filler-related Ophthalmic and Retinal Artery Occlusion. J Korean Med Sci. 2015;30(12):1847-55. PubMed PMID: 26713062.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Cerebral Angiographic Findings of Cosmetic Facial Filler-related Ophthalmic and Retinal Artery Occlusion. AU - Kim,Yong-Kyu, AU - Jung,Cheolkyu, AU - Woo,Se Joon, AU - Park,Kyu Hyung, Y1 - 2015/11/30/ PY - 2015/06/12/received PY - 2015/09/02/accepted PY - 2015/12/30/entrez PY - 2015/12/30/pubmed PY - 2016/10/8/medline KW - Autologous Fat KW - Cerebral Angiography KW - Facial Filler KW - Hyaluronic Acid KW - Retinal Artery Occlusion SP - 1847 EP - 55 JF - Journal of Korean medical science JO - J. Korean Med. Sci. VL - 30 IS - 12 N2 - Cosmetic facial filler-related ophthalmic artery occlusion is rare but is a devastating complication, while the exact pathophysiology is still elusive. Cerebral angiography provides more detailed information on blood flow of ophthalmic artery as well as surrounding orbital area which cannot be covered by fundus fluorescein angiography. This study aimed to evaluate cerebral angiographic features of cosmetic facial filler-related ophthalmic artery occlusion patients. We retrospectively reviewed cerebral angiography of 7 patients (4 hyaluronic acid [HA] and 3 autologous fat-injected cases) showing ophthalmic artery and its branches occlusion after cosmetic facial filler injections, and underwent intra-arterial thrombolysis. On selective ophthalmic artery angiograms, all fat-injected patients showed a large filling defect on the proximal ophthalmic artery, whereas the HA-injected patients showed occlusion of the distal branches of the ophthalmic artery. Three HA-injected patients revealed diminished distal runoff of the internal maxillary and facial arteries, which clinically corresponded with skin necrosis. However, all fat-injected patients and one HA-injected patient who were immediately treated with subcutaneous hyaluronidase injection showed preserved distal runoff of the internal maxillary and facial arteries and mild skin problems. The size difference between injected materials seems to be associated with different angiographic findings. Autologous fat is more prone to obstruct proximal part of ophthalmic artery, whereas HA obstructs distal branches. In addition, hydrophilic and volume-expansion property of HA might exacerbate blood flow on injected area, which is also related to skin necrosis. Intra-arterial thrombolysis has a limited role in reconstituting blood flow or regaining vision in cosmetic facial filler-associated ophthalmic artery occlusions. SN - 1598-6357 UR - https://www.unboundmedicine.com/medline/citation/26713062/Cerebral_Angiographic_Findings_of_Cosmetic_Facial_Filler_related_Ophthalmic_and_Retinal_Artery_Occlusion_ L2 - https://jkms.org/DOIx.php?id=10.3346/jkms.2015.30.12.1847 DB - PRIME DP - Unbound Medicine ER -