Abstract

Objectives: Present some clinical cases and try to give some more information to answer the question: Is intra-arterial injection using thrombolytic agents and hyaluronidase safe and efficient in H.A filler induced embolism of ophthalmic and cerebral arteries? Introduction: With global increase use hyaluronic acid filler, more and more complications. Ophthalmic artery and cerebral artery occlusion are the most severe complications of HA facial injection, of which the later is life threatening. In the literature, total vision recovery from complete blindness is rare. Recently, some medical centers have proposed intra-arterial injection of thrombolytic agents for ophthalmic artery occlusion. Yet, if cerebral embolism also occurred, treatment could be complicated. Materials / method: A prospective study on 6 patients with HA injection induced ophthalmic artery occlusion admitted into Viet Duc Hospital from December 2020 to March 2022. MRIs and CTA were performed if cerebral ischemia was suspected. Emergency intra-arterial injection using thrombolytic agents and hyaluronidase combined with local and systemic treatments was performed as no contraindication presented Results: All of the patients were diagnosed with ophthalmic or central retinal artery occlusion via digital subtraction angiography (DSA). Two patients presented with focal neurological signs with frontal lobe infarction on MRI result, altered consciousness, hemiparesis, and seizure. Three patients improved their vision acuity, 2 of which mostly recovered from no light perception (NLP) and light perception (LP), 1 recovered from NLP to LP. Among 3 patients who showed no vision improvement, 1 had a shrinking eyeball which needed prosthetics. Ptosis and ocular motility of all patients improved Conclusion: HA induced embolism of ophthalmic and cerebral arteries are severe complications. If correctly diagnosed and no contraindication is met, intra-arterial injection using thrombolytic agents and hyaluronidase is a safe and effective method that helps improve vision acuity and reversing cerebral ischemia with minimal risk