减少填充物的注射量可以预防继发性失明吗？

Does injecting small amounts of fillers prevent the development of secondary blindness?

Kyu-Ho Yi 1 2, Hyung-Jin Lee 3, Woo-Ram Kim 4, Min Ho An 5, Hyun-Jin Park 1, Hyewon Hu 1, Hee-Jin Kim 1

J Cosmet Dermatol. 2023 Jun 28.

PMID: 37381604

DOI: 10.1111/jocd.15898

INTRODUCTION

Aesthetic procedures such as botulinum neurotoxin injection and filler injection for anti-aging are highly getting popularity worldwide. Hyaluronic acid (HA) injections are often used for volume augmentation and wrinkle reduction. To avoid difficulties, understanding the vascular anatomy and filler content is crucial. Major fillers can cause vascular and nonvascular problems. Vascular complications include skin necrosis and visual problems. Non-vascular complications include inflammation, migration, Tyndall's effect, granulomas, and delayed hypersensitivity.

以肉毒毒素和透明质酸等作为填充材料的抗衰老方法在全球范围内越来越受欢迎。为了保证手术的安全性，充分了解血管解剖结构和填充物含量是至关重要的。填充物注射不当会导致血管问题和非血管问题。血管并发症包括皮肤坏死和视觉障碍。非血管并发症包括炎症、迁移、丁达尔效应、肉芽肿和迟发性超敏反应等。

Intravascular embolism is the most prevalent cause of ocular problems. The filler embolus flows back from the arterial branches above into the ophthalmic artery. Thereafter, the material is pushed down by arterial pressure into the central retinal and posterior ciliary arteries, which supplies the retina, causing secondary blindness. This condition is known as a retinal embolism(Figure 1).

血管内栓塞是发生视觉障碍最常见的原因。填充物栓子从上方的动脉分支流回眼动脉。此后，该物质被动脉压向下推入视网膜中央动脉和睫状后动脉，从而供应视网膜，导致继发性失明。这种情况被称为视网膜栓塞（图1）。

减少填充物的注射量可以预防继发性失明吗？

Injecting small amounts of filler can reportedly prevent blindness. In this study, we injected a filler into each branch of the ophthalmic artery that may be responsible for the potential loss of vision.

据报道，减少填充物的注射量可以预防失明。在这项研究中，研究团队在眼动脉的每个分支注射了一种可能导致潜在视力丧失的填充物。观察其在血管内的变化和走向。

*以原文为准

MATERIALS AND METHODS

A total of 51 ophthalmic arteries from 29 Korean cadavers (17 men and 12 women; mean age at death, 79.2; range, 61–92 years) were dissected to allow harvesting of the ophthalmic artery and its branches. After the dissection, 17 filler injections were introduced into the supratrochlear, supraorbital, and dorsal nasal arteries each. The amount of injected filler required to block the whole ophthalmic artery was measured using a ruler.

本研究选取29具韩国尸体，共51条眼动脉（17男12女；平均死亡年龄79.2岁；范围61-92岁），进行解剖以获得眼动脉及其分支。解剖后，分别向滑车上动脉、眶上动脉和鼻背动脉注入17支填充剂。使用标尺测量出阻塞整个眼动脉所需的填充物注射量。

After dissection, a polycprolactone (PCL) filler, Lafullen (Samyang Holdings Co., South Korea), for its white visible color, was injected into the supraorbital, supratrochlear, and dorsal nasal arteries, while blocking the other branches. The injection was administered and injected slowly from the distal end of the artery until it reached the origin of the ophthalmic artery. Measurements were performed using a ruler marked on the syringe (Figure 2).

解剖后，选择一种白色、辨识度高的聚己内酯（PCL）填充剂Lafullen（Samyang Holdings Co.，South Korea）注射到眶上动脉、滑车上动脉和鼻背动脉，同时阻断其他分支。注射从动脉的远端开始缓慢地给药和注射，直到眼动脉的起点。使用注射器上标记的标尺进行测量（图2）。

减少填充物的注射量可以预防继发性失明吗？

*以原文为准

RESULTS

The mean filler volume injected into the supratrochlear artery was 0.0397 ± 0.010 mL. The mean filler volume injected into the supraorbital artery measured 0.0409 ± 0.00932 mL (Table 1), and the dorsal nasal artery measured 0.0368 ± 0.00732 mL. There were no significant differences between these arteries and individual demographics (p> 0.05) (Figure 3).The micro-computed tomography of the ophthalmic artery and its branching arteries of supratrochlear, supraorbital, and dorsal nasal artery had obstructing volume of 0.0393 mL, 0.0483 mL, and 0.0371 mL, respectively (Figure 4).

注入滑车上动脉的填充物平均体积为（0.0397 ± 0.010） mL。注入眶上动脉的填充物平均体积测量为（0.0409 ± 0.00932） mL（表1），鼻背动脉测量值为（0.0368 ± 0.00732 ）mL。这些动脉与个体人口统计学资料之间没有显著差异（p>0.05）（图3）。滑车上动脉、眶上动脉和鼻背动脉的眼动脉及其分支动脉的显微计算机断层扫描显示，阻塞体积分别为0.0393 mL，0.0483 mL和0.0371 mL（图4）。

减少填充物的注射量可以预防继发性失明吗？

Even a modest amount of filler injection can completely block the ophthalmic artery, resulting in visual loss.

结果表明，即使注射少量的填充物，同样会导致眼动脉栓塞，导致视力障碍。

*以原文为准

DISCUSSION

Numerous strategies have been suggested to prevent this secondary blindness. The use of Doppler ultrasound-guided injections has been recommended as a preventive method. Additionally, the use of a cannula, rather than a needle, prevents arterial puncture. Because the essential arteries (dorsal nasal, supratrochlear, and supraorbital arteries) have a diameter of approximately 1 mm, larger diameter cannulas are typically safer than smaller diameter cannulas. An artery cannot be penetrated by a cannula with a relatively large diameter according to a comparison diagram between arterial diameter and cannula.

目前，已经有许多方法用以预防注射导致的继发性失明。比如建议使用多普勒超声引导注射。此外，使用钝针而不是针头可以防止动脉穿刺。由于基本动脉（鼻背动脉、滑车上动脉和眶上动脉）的直径约为1mm，因此较大直径的钝针通常比较小直径的更安全。根据动脉直径和钝针之间的比较图，动脉不能被直径相对较大的钝针穿透。

In the study we conducted micro computed tomography to confirm the result of dissection based study, and found out there were no differences between them. The micro computed tomography method allows a three-dimensional observation with wholemount staining for contrast enhancement. A precise anatomical understanding of the anatomical structures could be analyzed and measured.

研究团队进行了显微计算机断层扫描，以确认基于解剖层面的研究结果，并发现它们之间没有差异。微型计算机断层扫描方法允许通过体染色进行三维观察，以增强对比度。可以分析和测量解剖结构。

The lack of data from live humans limits this study's findings. Information on the actual arterial pressures can be used to determine whether blindness would occur in a live person. Actual ejection pressures are reportedly substantially higher than blood pressure.This indicates that even a tiny filler injection is sufficient to raise the opthalmic artery pressure.

本研究局限性在于由于缺乏来自活体数据。据报道，实际的射血压力远高于血压。这就说明即使是微小的填充物注射也足以增加眼动脉压力，导致视力障碍。

*以原文为准

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