Retrobulbar Hyaluronidase to reverse CRAO following injection of facial fillers

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Retrobulbar Hyaluronidase to reverse CRAO following injection of facial fillers.

The consensus is both in review and animal studies1-8 that, as yet, there is not conclusive evidence to support this treatment. Only a limited number of case reports and theoretical proposals have been recorded in support of the technique9,10. Thus, it is our advice that ophthalmology units do not need to be equipped to provide an emergency retrobulbar hyaluronidase service. Best practice dictates that all practitioners should be aware of the complications of the procedures they administer, discuss these with their patients and equip themselves (or establish a robust pathway) to treat any immediate complication should it arise.

References;
1. Examining the Role of Retrobulbar Hyaluronidase in Reversing Filler-Induced Blindness: A Systematic Review.
Paap MK, Milman T, Ugradar S, Goldberg R, Silkiss RZ.
Ophthalmic Plast Reconstr Surg. 2019 Dec 24. doi: 10.1097/IOP.0000000000001568.
2. Assessing Retrobulbar Hyaluronidase as a Treatment for Filler-Induced Blindness in a Cadaver Model.
Paap MK, Milman T, Ugradar S, Silkiss RZ.
Plast Reconstr Surg. 2019 Aug;144(2):315-320. doi: 10.1097/PRS.0000000000005806.
3. Effectiveness of Retrobulbar Hyaluronidase Injection in an Iatrogenic Blindness Rabbit Model Using Hyaluronic Acid Filler Injection.
Lee W, Oh W, Ko HS, Lee SY, Kim KW, Yang EJ.
Plast Reconstr Surg. 2019 Jul;144(1):137-143. doi: 10.1097/PRS.0000000000005716.
4 Role of Retrobulbar Hyaluronidase in Filler-Associated Blindness: Evaluation of Fundus Perfusion and Electroretinogram Readings in an Animal Model.
Hwang CJ, Mustak H, Gupta AA, Ramos RM, Goldberg RA, Duckwiler GR.
Ophthalmic Plast Reconstr Surg. 2019 Jan/Feb;35(1):33-37. doi: 10.1097/IOP.0000000000001132.
5. Efficacy of Retrobulbar Hyaluronidase Injection for Vision Loss Resulting from Hyaluronic Acid Filler Embolization.
Zhu GZ, Sun ZS, Liao WX, Cai B, Chen CL, Zheng HH, Zeng L, Luo SK.
Aesthet Surg J. 2017 Dec 13;38(1):12-22. doi: 10.1093/asj/sjw216.
6. An In Vitro Model Assessing the Penetration of Hyaluronidase through Optic Nerve Dura for Management of Hyaluronic Acid Facial Filler Embolism.
Adulkar N, Cheng C, Lee L, Rasmussen S, Dolman PJ, Yin VT.
Plast Reconstr Surg. 2019 Jul;144(1):43e-47e. doi: 10.1097/PRS.0000000000005714.
7. Blindness After Facial Filler Injections: The Role of Extravascular Hyaluronidase on Intravascular Hyaluronic Acid Embolism in the Rabbit Experimental Model.
Zhang L, Feng X, Shi H, Wu WTL, Wu S.
Aesthet Surg J. 2019 Oct 21. pii: sjz280. doi: 10.1093/asj/sjz280. [Epub ahead of print] 8. Intra-Arterial Thrombolytic Therapy Is Not a Therapeutic Option for Filler-Related Central Retinal Artery Occlusion.
Chen YC, Wu HM, Chen SJ, Lee HJ, Lirng JF, Lin CJ, Chang FC, Luo CB, Guo WY.
Facial Plast Surg. 2018 Jun;34(3):325-329. doi: 10.1055/s-0037-1621730. Epub 2018 Jan 29. Review
9. Retro or PeriBulbar Injection Techniques to Reverse Visual Loss After Filler Injections.
Carruthers J, Fagien S, Dolman P.
Dermatol Surg. 2015 Dec;41 Suppl 1:S354-7. doi: 10.1097/DSS.0000000000000558.
10. Severe vision loss caused by cosmetic filler augmentation: Case series with review of cause and therapy.
Thanasarnaksorn W, Cotofana S, Rudolph C, Kraisak P, Chanasumon N, Suwanchinda A.
J Cosmet Dermatol. 2018 Oct;17(5):712-718. doi: 10.1111/jocd.12705. Epub 2018 Jul 13.

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