title: Intravenous Hyaluronidase with Urokinase as Treatment for Rabbit Retinal Artery Hyaluronic Acid Embolism.
abstract: BACKGROUND
  Although various salvage methods have been proposed to treat intraretinal artery hyaluronic acid embolism, their applications are still limited by various factors. The authors investigated the effectiveness of intravenous hyaluronidase with urokinase for resolving retinal artery hyaluronic acid embolism.
  
  
  METHODS
  The anatomy of rabbit ophthalmic and fundus arteries (retinal and choroid artery) was studied. Approximately 0.35 ml of hyaluronic acid was injected into the ophthalmic artery to create a retinal artery embolism model. The rabbits were grouped randomly (groups A, B, C, D, E, and F) and given hyaluronidase with urokinase intravenously at different postobstruction time points (10, 20, 30, 40, 50, and 60 minutes). Saline was given to the control group. Fundus vascular (retinal and choroid artery) reperfusion status and the effectiveness of the solution on the obstruction of each group were observed for 5 days.
  
  
  RESULTS
  The animal model closely imitated actual hyaluronic acid ophthalmic/retinal artery obstructions. Three vascular conditions were observed after hyaluronidase with urokinase injection: total, partial, and no reperfusion. Groups A, B, and C showed a significantly higher overall solution effectiveness rate (total/partial reperfusion) compared with the control group (p = 0.001, p = 0.001, and p = 0.005, respectively). Solution effectiveness in groups D, E, and F showed no difference compared with the control group (p = 0.628, p = 1.000, and p = 1.000, respectively). The effectiveness of the solution drops dramatically if given after 30 minutes of obstruction.
  
  
  CONCLUSIONS
  The authors' method can indeed help resolve retinal artery hyaluronic acid obstruction. Intravenous hyaluronidase with urokinase technique shows possible potential to become a standardized treatment protocol for intraretinal artery hyaluronic acid embolism with further clinical tests.
authors.affiliation: Shanghai, People's Republic of China.|From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Affiliated to the School of Medicine Shanghai Jiao Tong University.
authors.forename: ChengAn
authors.initials: C
authors.lastname: Chiang
authors.affiliation: Shanghai, People's Republic of China.|From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Affiliated to the School of Medicine Shanghai Jiao Tong University.
authors.forename: ShuangBai
authors.initials: S
authors.lastname: Zhou
authors.affiliation: Shanghai, People's Republic of China.|From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Affiliated to the School of Medicine Shanghai Jiao Tong University.
authors.forename: ChuHsin
authors.initials: C
authors.lastname: Chen
authors.affiliation: Shanghai, People's Republic of China.|From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Affiliated to the School of Medicine Shanghai Jiao Tong University.
authors.forename: Dave S
authors.initials: DS
authors.lastname: Ho
authors.affiliation: Shanghai, People's Republic of China.|From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Affiliated to the School of Medicine Shanghai Jiao Tong University.
authors.forename: HuiZhong
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Shanghai, People's Republic of China.|From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Affiliated to the School of Medicine Shanghai Jiao Tong University.
authors.forename: Kai
authors.initials: K
authors.lastname: Liu
mesh_terms: D000818:Animals; D003357:Cosmetic Techniques / Q000009:adverse effects*; D000067548:Dermal Fillers / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D004617:Embolism / Q000139:chemically induced / Q000188:drug therapy*; D006820:Hyaluronic Acid / Q000009:adverse effects*; D006821:Hyaluronoglucosaminidase / Q000008:administration & dosage* / Q000627:therapeutic use; D007275:Injections, Intravenous; D008297:Male; D011817:Rabbits; D011897:Random Allocation; D015356:Retinal Artery Occlusion / Q000139:chemically induced / Q000188:drug therapy*; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage* / Q000627:therapeutic use
chemical_list: D000067548:Dermal Fillers; D006820:Hyaluronic Acid; D006821:Hyaluronoglucosaminidase; D014568:Urokinase-Type Plasminogen Activator