Clinical Study on Artery Embolization Caused by Cosmetic Facial Filler Injections

doi:10.3969/j.issn.1673-5765.2017.10.004

Abstract

Abstract:

Objective To investigate the clinical manifestations, mechanism and prognosis of artery embolization resulting from cosmetic facial filler injections. Methods Ten patients with artery embolization caused by cosmetic facial filler injections in Beijing Tongren Hospital from January 2013 to August 2016 were included consecutively. The clinical data including filler materials, injection sites, best-corrected visual acuity (BCVA), associated ocular and neurological manifestations, fundus fluorescein angiography (FFA), brain magnetic resonance imaging (MRI) were analyzed. Results Among 10 cases, 8 cases had ophthalmic artery occlusion (OAO), and 2 cases had central retinal artery occlusion (CRAO). Among which, 2 cases had ophthalmic artery occlusion accompanied with cerebral infarction (CI), and 3 cases had ophthalmic artery occlusion accompanied with ophthalmoplegia. Injection material included hyaluronic acid (6 cases), autologous fat (3 cases), and collagen (1 case). Injection sites were frontal area (3 cases), nose area and nasal area (2 cases), nasolabial area (2 cases), glabellar area (2 cases), and periocular area (1 case). Two cases with autologous fat injections had combined CI. The initial and finial BCVA of all cases had no light perception. Conclusion Cosmetic facial filler injections can cause artery embolization. Under the pressure of injection, the injectant may get into the orbital artery and retrograde to the ophthalmic artery and its branches, which resulting in blindness. In some cases, retrograde artery embolism can causes CI. The incidence of CI was higher with autologous fat injection than hyaluronic acid injection. The visual outcome of iatrogenic retinal artery occlusion was poor, so that strategies aimed at preventing were essential.

Key words: Cosmetic facial filler injection; Artery embolization; Ophthalmic artery occlusion; Cerebral infarction

摘要：

目的研究面部注射填充后引发动脉栓塞的临床特征、发病机制及预后。方法共纳入2013年1月-2016年8月首都医科大学附属北京同仁医院诊治的面部注射填充后引发动脉栓塞患者10例，分析所有患者的注射材料、注射部位、最佳矫正视力、相关眼部及神经系统症状、眼底荧光血管造影、头核磁共振成像等临床资料。结果 10例患者中，眼动脉阻塞8例，视网膜中央动脉阻塞2例。其中2例眼动脉阻塞伴随脑梗死，3 例眼动脉阻塞伴眼外肌麻痹。注射材料包括透明质酸（6例）、自体脂肪（3例）、胶原蛋白（1例），注射部位有额部（3例）、鼻部（2例）、鼻唇沟（2例）、眉间（2例）、眶周（1例）。注射自体脂肪的患者有 2例合并脑梗死。所有患者初始和最终最佳矫正视力无光感。结论面部注射填充可能会引起动脉栓塞。在注射压力下，注射物可能会进入眶周围动脉，逆流进入眼动脉及其分支导致失明。在一些情况下，逆行动脉栓塞也会导致脑梗死。自体脂肪注射比透明质酸注射更易引起脑梗死。医源性视网膜动脉阻塞预后差，因此预防措施很关键。

关键词: 面部注射填充; 动脉栓塞; 眼动脉阻塞; 脑梗死

WANG Xiao-Nan,JIANG Han-Qiu, LU Ning, WANG Jia-Wei. Clinical Study on Artery Embolization Caused by Cosmetic Facial Filler Injections[J]. Chinese Journal of Stroke, 2017, 12(10): 900-905.

汪晓楠，江汉秋，卢宁，王佳伟. 面部注射填充引发动脉栓塞的临床研究[J]. 中国卒中杂志, 2017, 12(10): 900-905.

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