Xiao Xu1, Guiwen Zhou2, Qiang Fu2, Lixia Zhang2, Youtao Yu3, Ying Dong3, Liming Liang2, Minliang Chen2. 1. Department of Ophthalmology of The Third Medical Center of Chinese, PLA General Hospital. 2. Department of Burns and Plastic Surgery of The Forth Medical Center of Chinese, PLA General Hospital. 3. Department of Interventional of The Forth Medical Center of Chinese, PLA General Hospital.
Abstract
BACKGROUND: The incidence of hyaluronic acid (HA) embolism has increased markedly in recent years. HA embolism can lead to serious complications such as blindness, eye and eyelid movement disorders, skin necrosis, and cerebral embolism. However, there is a lack of robust clinical evidence regarding the benefits of treatment of HA embolism with intra-arterial thrombolytic therapy (IATT). METHODS: In the present study, we enrolled 45 patients with decreased visual acuity, including 40 patients with symptoms of vision loss, and 8 patients with symptoms of intracranial embolism. The patients underwent emergency IATT via hyaluronidase and papaverine injections, followed by conventional sequential therapy. RESULTS: In the 45 patients with symptoms of vision loss, 16 (36%) exhibited improvements in final visual acuity, even when the clinical application of the thrombolytic treatments was performed beyond the recommended window for optimal treatment. The facial skin necrosis of all patients was restored to near normal appearance. Notably, for 8 patients with suspected symptoms of intracranial infarction we performed cerebral angiography and IATT, and in 2 patients obtained partial recanalization of the obstruction,the symptoms of heavy headache and binocular distension pain was improved in 1 patient with intracranial embolism after IATT treatment. CONCLUSION: Our results indicate that IATT is feasible for patients with vision loss induced by HA embolism. IATT combined with conventional sequential therapy was beneficial in the recovery from other serious HA embolism complications. Nevertheless, the underlying pathophysiological mechanism needs to be clarified in future animal experiments. This article is protected by copyright. All rights reserved.
BACKGROUND: The incidence of hyaluronic acid (HA) embolism has increased markedly in recent years. HA embolism can lead to serious complications such as blindness, eye and eyelid movement disorders, skin necrosis, and cerebral embolism. However, there is a lack of robust clinical evidence regarding the benefits of treatment of HA embolism with intra-arterial thrombolytic therapy (IATT). METHODS: In the present study, we enrolled 45 patients with decreased visual acuity, including 40 patients with symptoms of vision loss, and 8 patients with symptoms of intracranial embolism. The patients underwent emergency IATT via hyaluronidase and papaverine injections, followed by conventional sequential therapy. RESULTS: In the 45 patients with symptoms of vision loss, 16 (36%) exhibited improvements in final visual acuity, even when the clinical application of the thrombolytic treatments was performed beyond the recommended window for optimal treatment. The facial skin necrosis of all patients was restored to near normal appearance. Notably, for 8 patients with suspected symptoms of intracranial infarction we performed cerebral angiography and IATT, and in 2 patients obtained partial recanalization of the obstruction,the symptoms of heavy headache and binocular distension pain was improved in 1 patient with intracranial embolism after IATT treatment. CONCLUSION: Our results indicate that IATT is feasible for patients with vision loss induced by HA embolism. IATT combined with conventional sequential therapy was beneficial in the recovery from other serious HA embolism complications. Nevertheless, the underlying pathophysiological mechanism needs to be clarified in future animal experiments. This article is protected by copyright. All rights reserved.
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Keywords:
HA injection complication; artery occlusion; intra-arterial thrombolytic therapy