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Effectiveness of Retrobulbar Hyaluronidase Injection in an Iatrogenic Blindness Rabbit Model Using Hyaluronic Acid Filler Injection

Lee, Won M.D., Ph.D.; Oh, Wook M.D.; Ko, Hyung-Seok M.D.; Lee, Sang-Young M.D.; Kim, Ki Wook M.D.; Yang, Eun-Jung M.D., Ph.D.

Plastic and Reconstructive Surgery: July 2019 - Volume 144 - Issue 1 - p 137-143
doi: 10.1097/PRS.0000000000005716

Background: Blindness caused by soft-tissue filler injection is the most tragic complication, with no standard treatments until recently. Retrobulbar hyaluronidase injection has been proposed as the treatment, but its effectiveness in visual compromise remains to be determined. The authors aimed to determine the effectiveness of retrobulbar hyaluronidase using soft-tissue filler in an iatrogenic blindness animal model.

Methods: New Zealand White rabbits were used to simulate the hyaluronic acid–associated vascular occlusion model. A volume of 0.7 to 1.6 ml of hyaluronic acid filler was injected into the internal carotid artery to create a retinal artery occlusion. The rabbits were administered retrobulbar hyaluronidase (3000 IU) at different postobstruction time points (5 and 10 minutes). No intervention was given to the control group. Fundus photography was performed before and immediately after the filler injection and immediately after the administration of retrobulbar hyaluronidase. Electroretinography was performed after 60 minutes to confirm the retinal reperfusion and electrophysiologic function.

Results: All of the experimental eyes recorded total occlusion after hyaluronic acid injection. Three eyes with a completely occluded retinal artery following retrobulbar hyaluronidase treatment showed improved retinal reperfusion by fundus photography and corresponding electroretinography. Despite administration of the retrobulbar hyaluronidase injection, one completely occluded eye showed no improvement in perfusion. All of the control eyes recorded complete occlusion 1 hour after hyaluronic acid filler injection.

Conclusions: Retrobulbar hyaluronidase may be an effective evidence-based treatment option for humans. Hyaluronidase concentration and injection time are the important factors for faster recovery, but additional studies are still required.

Anyang, Seoul, and Cheonju, Republic of Korea

From Yonsei E1 Plastic Surgery Clinic; Samsung Feel Clinic; Samsung Lohas Clinic; Korea Leaders Medical Group; Regen Clinic; and the Department of Plastic and Reconstructive Surgery, Hanyang University Seoul Hospital, Hanyang University, College of Medicine.

Received for publication August 14, 2018; accepted December 11, 2018.

Disclosure:Dr. Won Lee has been an investigator, speaker, and consultant for JETEMA Co., Ltd., South Korea. The hyaluronic acid fillers, e.p.t.q. S100, were sponsored by JETEMA. The remaining authors have no financial interest to declare in relation to the content of this article.

Eun-Jung Yang, M.D., Ph.D., Department of Plastic and Reconstructive Surgery, Hanyang University Seoul Hospital Hanyang University, College of Medicine 222-1, Wangsimni-ro, Seongdong-gu, Seoul, Republic of Korea,

Copyright © 2019 by the American Society of Plastic Surgeons