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Objective@#To compare the clinical effects of urokinase thrombolytic therapy for optic artery occlusion (OAO) and retinal artery occlusion (RAO) caused by facial microinjection with hyaluronic acid and spontaneous RAO.@*Methods@#From January 2014 to February 2018, 22 eyes of 22 patients with OAO and RAO caused by facial microinjection of hyaluronic acid who received treatment in Xi'an Fourth Hospital were enrolled in this retrospective study (hyaluronic acid group). Twenty-two eyes of 22 patients with spontaneous RAO were selected as the control group. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logMAR visual acuity. FFA was used to measure arm-retinal circulation time (A-Rct) and filling time of retinal artery and its branches (FT). Meanwhile, MRI examination was performed. There were significant differences in age and FT between the two groups (t=14.840, 3.263; P=0.000, 0.003). The differecens of logMAR visual acuity, onset time and A-Rct were not statistically significant between the two groups (t=0.461, 0.107, 1.101; P=0.647, 0.915, 0.277). All patients underwent urokinase thrombolysis after exclusion of thrombolytic therapy. Among the patients in the hyaluronic acid group and control group, there were 6 patients of retrograde ophthalmic thrombolysis via the superior pulchlear artery, 6 patients of retrograde ophthalmic thrombolysis via the internal carotid artery, and 10 patients of intravenous thrombolysis. FFA was reviewed 24 h after treatment, and A-Rct and FT were recorded. Visual acuity was reviewed 30 days after treatment. The occurrence of adverse reactions during and after treatment were observed. The changes of logMAR visual acuity, A-Rct and FT before and after treatment were compared between the two groups using ttest.@*Results@#At 24 h after treatment, the A-Rct and FT of the hyaluronic acid group were 21.05±3.42 s and 5.05±2.52 s, which were significantly shorter than before treatment (t=4.569, 2.730; P=0.000, 0.000); the A-Rct and FT in the control group were 19.55±4.14 s and 2.55±0.91 s, which were significantly shorter than before treatment (t=4.114, 7.601; P=0.000, 0.000). There was no significant difference in A-Rct between the two groups at 24 h after treatment (t=1.311, P=0.197). The FT difference was statistically significant between the two groups at 24 h after treatment (t=4.382, P=0.000). There was no significant difference in the shortening time of A-Rct and FT between the two groups (t=0.330, 0.510; P=0.743, 0.613). At 30 days after treatment, the logMAR visual acuity in the hyaluronic acid group and the control group were 0.62±0.32 and 0.43±0.17, which were significantly higher than those before treatment (t=2.289, 5.169; P=0.029, 0.000). The difference of logMAR visual acuity between the two groups after treatment was statistically significant (t=2.872, P=0.008). The difference in logMAR visual acuity before and after treatment between the two groups was statistically significant (t=2.239, P=0.025). No ocular or systemic adverse reactions occurred during or after treatment in all patients.@*Conclusions@#Urokinase thrombolytic therapy for OAO and RAO caused by facial microinjection with hyaluronic acid and spontaneous RAO is safe and effective, with shortening A-Rct, FT and improving visual acuity. However, the improvement of visual acuity after treatment of OAO and RAO caused by facial microinjection with hyaluronic acid is worse than that of spontaneous RAO.
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Objective To compare the clinical effects ofurokinase thrombolytic therapy for optic artery occlusion (OAO) and retinal artery occlusion (RAO) caused by facial microinjection with hyaluronic acid and spontaneous RAO.Methods From January 2014 to February 2018,22 eyes of 22 patients with OAO and RAO caused by facial microinjection of hyaluronic acid who received treatment in Xi'an Fourth Hospital were enrolled in this retrospective study (hyaluronic acid group).Twenty-two eyes of 22 patients with spontaneous RAO were selected as the control group.The BCVA examination was performed using the international standard visual acuity chart,which was converted into logMAR visual acuity.FFA was used to measure arm-retinal circulation time (A-Rct) and filling time of retinal artery and its branches (FT).Meanwhile,MRI examination was performed.There were significant differences in age and FT between the two groups (t=14.840,3.263;P=0.000,0.003).The differecens of logMAR visual acuity,onset time and A-Rct were not statistically significant between the two groups (t=0.461,0.107,1.101;P=0.647,0.915,0.277).All patients underwent urokinase thrombolysis after exclusion of thrombolytic therapy.Among the patients in the hyaluronic acid group and control group,there were 6 patients of retrograde ophthalmic thrombolysis via the superior pulchlear artery,6 patients of retrograde ophthalmic thrombolysis via the internal carotid artery,and 10 patients of intravenous thrombolysis.FFA was reviewed 24 h after treatment,and A-Rct and FT were recorded.Visual acuity was reviewed 30 days after treatment.The occurrence of adverse reactions during and after treatment were observed.The changes of logMAR visual acuity,A-Rct and FT before and after treatment were compared between the two groups using ttest.Results At 24 h after treatment,the A-Rct and FT of the hyaluronic acid group were 21.05 ± 3.42 s and 5.05± 2.52 s,which were significantly shorter than before treatment (t=4.569,2.730;P=0.000,0.000);the A-Rct and FT in the control group were 19.55 ± 4.14 s and 2.55± 0.91 s,which were significantly shorter than before treatment (t=4.114,7.601;P=0.000,0.000).There was no significant difference in A-Rct between the two groups at 24 h after treatment (t=l.311,P=0.197).The FT difference was statistically significant between the two groups at 24 h after treatment (t=4.382,P=0.000).There was no significant difference in the shortening time of A-Rct and FT between the two groups (t=0.330,0.510;P=0.743,0.613).At 30 days after treatment,the logMAR visual acuity in the hyaluronic acid group and the control group were 0.62± 0.32 and 0.43± 0.17,which were significantly higher than those before treatment (t=2.289,5.169;P=0.029,0.000).The difference of logMAR visual acuity between the two groups after treatment was statistically significant (t=2.872,P=0.008).The difference in logMAR visual acuity before and after treatment between the two groups was statistically significant (t=2.239,P=0.025).No ocular or systemic adverse reactions occurred during or after treatment in all patients.Conclusions Urokinase thrombolytic therapy for OAO and RAO caused by facial microinjection with hyaluronic acid and spontaneous RAO is safe and effective,with shortening A-Rct,FT and improving visual acuity.However,the improvement of visual acuity after treatment of OAO and RAO caused by facial microinjection with hyaluronie acid is worse than that of spontaneous RAO.
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Objetivo: Describir las características clínicas y el resultado visual de un grupo de pacientes con complicaciones de procedimientos estéticos faciales que acudieron a consulta a la clínica de oftalmología de Cali. Diseño y Métodos: Estudio observacional descriptivo serie de casos. Resultados: Nueve casos, seis mujeres y tres hombres con edad media de 45 años (R: 25-65 años). Seis pacientes con complicaciones vasculares de rellenos faciales. Una obstrucción de la arteria oftálmica, dos de arteria central de la retina y tres de rama arterial. Tres casos de trauma penetrante con aguja durante anestesia para tatuaje palpebral con agudeza visual de PL, CD y NPL y diagnóstico de endoftalmitis, hemorragia vítrea y atrofia óptica, respectivamente, los dos primeros fueron tratados con cirugía. Todos los procedimientos fueron realizados por cosmetólogas. A excepción de un caso, todos tuvieron agudeza visual peor de 20/400 al final del seguimiento. Tres casos fueron NPL. Conclusiones: La pérdida de la visión severa e irreversible es una complicación rara pero devastadora de procedimientos estéticos faciales. Visiones finales peores de 20/400 ocurrieron en 88 % del total de los casos y 33.3% quedan NPL. Debido a que no existe tratamiento efectivo para el embolismo por sustancias diferentes al ácido hialurónico, la principal medida es la prevención.
Objective: To describe the clinical characteristics and visual outcome of a group of patients with complications of facial aesthetic procedures who came to the Cali ophthalmology clinic. Design and Methods: Observational study descriptive series of cases. Results: Nine cases, six women and three men with mean age of 45 years (range: 25-65 years). Six patients with vascular complications of facial fi llings. One of them presented occlusion of the ophthalmic artery, two have occlusion of central artery of the retina and three have occlusion of arterial branch. Three cases of penetrating trauma with a needle during anesthesia for palpebral tattoo with visual acuity of LP, CF and NLP and diagnosis of endophthalmitis, vitreous hemorrhage and optic atrophy respectively, the first two were treated with surgery. Cosmetologists performed all procedures. With the exception of one case, all of the patients had visual acuity worse than 20/400 at the end of follow-up. Three cases were NLP. Conclusions: Severe and irreversible loss of vision is a rare but devastating complication of facial aesthetic procedures. Final worst visions of 20/400 occur in 88% of the total cases and 33.3% are NLPs. Because there is no effective treatment for embolism by substances other than hyaluronic acid, the main measure is prevention.