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“Effectiveness of retrobulbar hyaluronidase injection in an iatrogenic blindness rabbit model using hyaluronic acid filler injection”

Lee, Won MD, PhD1; Oh, Wook MD2; Ko, Hyung-Seok MD3; Lee, Sang-Young MD4; Kim, Ki Wook MD5; Yang, Eun-Jung MD, PhD6

Plastic and Reconstructive Surgery: April 15, 2019 - Volume PRS Online First - Issue - p
doi: 10.1097/PRS.0000000000005716
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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 rabbits were used to simulate the hyaluronic acid (HA)-associated vascular occlusion model. A volume of 0.7-1.6 ml of HA filler was injected into the internal carotid artery to create a retinal artery occlusion. The rabbits were administered retrobulbar hyaluronidase (3000 IU) at different post-obstruction time points (5 and 10 min). 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. Electroretinogram was performed after 60 min to confirm the retinal reperfusion and electrophysiological function.

Results: All of the experimental eyes recorded total occlusion after HA injection. Three eyes with completely occluded retinal artery following retrobulbar hyaluronidase treatment showed improved retinal reperfusion by fundus photography and corresponding electroretinogram. 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 h following HA filler injection.

Conclusion: 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.

1Yonsei E1 Plastic Surgery Clinic, Anyang, South Korea

2Samsung Feel Clinic, Seoul, South Korea

3Samsung Lohas Clinic, Cheonju, South Korea

4Korea Leaders Medical Group, Seoul, South Korea

5Regen Clinic, Seoul, South Korea

6Dept. of Plastic and Reconstructive Surgery, Cheil General Hospital and Women’s Healthcare center, Dankook University, College of Medicine, South Korea

Financial Disclosure Statement: 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 Co., LTD., South Korea.

Corresponding author:Eunjung Yang, Eun-Jung Yang, MD. PhD., Assistant Professor, Department of Plastic and Reconstructive Surgery, Cheil General Hospital and Woman’s Healthcare Center, Dankook University, College of Medicine, South Korea. enyang7@gmail.com

©2019American Society of Plastic Surgeons