title: 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.
authors.affiliation: 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.
authors.forename: Yong-Kyu
authors.identifier: 0000-0002-6850-1835
authors.initials: YK
authors.lastname: Kim
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Cheolkyu
authors.identifier: 0000-0002-8862-7347
authors.initials: C
authors.lastname: Jung
authors.affiliation: Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Se Joon
authors.identifier: 0000-0003-3692-7169
authors.initials: SJ
authors.lastname: Woo
authors.affiliation: Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Kyu Hyung
authors.identifier: 0000-0002-5516-8121
authors.initials: KH
authors.lastname: Park
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation; D000328:Adult; D000368:Aged; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000628:therapy; D002533:Cerebral Angiography; D003357:Cosmetic Techniques / Q000009:adverse effects; D000067548:Dermal Fillers / Q000008:administration & dosage / Q000009:adverse effects*; D005145:Face; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000009:adverse effects; D006821:Hyaluronoglucosaminidase / Q000008:administration & dosage; D007279:Injections, Subcutaneous; D009880:Ophthalmic Artery / Q000000981:diagnostic imaging*; D015356:Retinal Artery Occlusion / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies; D014182:Transplantation, Autologous / Q000009:adverse effects; D055815:Young Adult
chemical_list: D000067548:Dermal Fillers; D006820:Hyaluronic Acid; D006821:Hyaluronoglucosaminidase
keywords: Autologous Fat; Cerebral Angiography; Facial Filler; Hyaluronic Acid; Retinal Artery Occlusion