【 文献重点摘要 】
 

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.

Keywords: Retinal Artery Occlusion; Hyaluronic Acid; Autologous Fat; Facial Filler; Cerebral Angiography

美容面部填充物相关的眼动脉闭塞是罕见的，但是一个毁灭性的并发症，而确切的病理生理仍然是难以捉摸的。脑血管造影提供了眼动脉和眼眶周围区域更详细的血流信息，而眼底荧光血管造影无法覆盖这些区域。本研究旨在评价面部美容填充物相关眼动脉闭塞患者的脑血管造影特征。回顾性分析7例面部美容填充物注射后眼动脉及其分支闭塞的脑血管造影资料，其中4例为透明质酸(HA)，3例为自体脂肪注射，均行动脉内溶栓治疗。在选择性眼动脉造影上，注脂患者均显示眼动脉近端有较大的充盈缺损，而注射HA的患者眼动脉远端分支闭塞。3例注射HA的患者显示上颌面内动脉远端流出减少，临床上与皮肤坏死相对应。然而，所有注射脂肪的患者和一名立即接受透明质酸酶皮下注射的患者显示，上颌和面部内动脉的远端流出保留下来，并出现轻微的皮肤问题。注射材料之间的大小差异似乎与不同的血管造影结果有关。自体脂肪更容易阻塞眼动脉近端，而透明质酸则更容易阻塞远端分支。此外，HA的亲水性和扩容特性可能会加剧注射部位的血流，这也与皮肤坏死有关。在美容面部填充物相关的眼动脉闭塞中，动脉内溶栓在重建血流或恢复视力方面的作用有限。

关键词：视网膜动脉阻塞；透明质酸；自体脂肪；面部填充物；脑血管造影术