2017-18 HSC Section 4 Green Book

Reprinted by permission of Dermatol Surg. 2015; 41(10):1097-1117.

REVIEW ARTICLE

Avoiding and Treating Blindness From Fillers: A Review of the World Literature Katie Beleznay, MD, FRCPC, FAAD,* Jean D. A. Carruthers, MD, FRCSC, FRC (OPHTH), FASOPRS, † Shannon Humphrey, MD, FRCPC, FAAD,* and Derek Jones, MD ‡ x

BACKGROUND As the popularity of soft tissue fillers increases, so do the reports of adverse events. The most serious complications are vascular in nature and include blindness.

OBJECTIVE To review the cases of blindness after filler injection, to highlight key aspects of the vascular anatomy, and to discuss prevention and management strategies.

METHODS A literature review was performed to identify all the cases of vision changes from filler in the world literature.

RESULTS Ninety-eight cases of vision changes from filler were identified. The sites that were high risk for complications were the glabella (38.8%), nasal region (25.5%), nasolabial fold (13.3%), and forehead (12.2%). Autologous fat (47.9%) was the most common filler type to cause this complication, followed by hyaluronic acid (23.5%). The most common symptoms were immediate vision loss and pain. Most cases of vision loss did not recover. Central nervous system complications were seen in 23.5% of the cases. No treatments were found to be consistently successful in treating blindness.

CONCLUSION Although the risk of blindness from fillers is rare, it is critical for injecting physicians to have a firm knowledge of the vascular anatomy and to understand key prevention and management strategies.

The authors have indicated no significant interest with commercial supporters.

F illers have become an important treatment for patients who seek noninvasive rejuvenation. However, as the fi eld of soft tissue augmentation becomes increasingly popular, reports of adverse events have increased. The most serious complications are vascular in nature and can lead to blindness. To highlight the signi fi cance of this issue, the Food and Drug Administration recently issued a safety communication about the risk of intravascular injection with soft tissue fi llers. 1 Having a thorough understanding of the vascular anatomy before injecting is critical. In this article, the authors review 98 cases of ocular complications

secondary to soft tissue fi llers and discuss the vascular anatomy and prevention and management strategies. To the knowledge of the authors, this is the largest review of blindness secondary to fi llers in the literature.

Methods

A literature search was performed to gather informa- tion on ocular complications after injection of soft tissue fi llers from reports published up to January 2015. The databases of the National Library of Medicine, Ovid MEDLINE, and Cochrane Library were searched using the following Boolean string: (soft tissue augmentation OR fi ller OR injectable) AND

Departments of *Dermatology and Skin Science, and † Ophthalmology and Visual Science, University of British Columbia, Vancouver, British Columbia, Canada; ‡ Skin Care and Laser Physicians of Beverly Hills; x Division of Dermatology, University of California at Los Angeles, Los Angeles, California © 2015 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved. ISSN: 1076-0512 · Dermatol Surg 2015;41:1097 – 1117 · DOI: 10.1097/DSS.0000000000000486

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