Effect of urokinase thrombolytic therapy for optic artery and retinal artery occlusion caused by facial microinjection with hyaluronic acid and spontaneous retinal artery occlusion_Chinese Journal of Ocular Fundus Diseases

Authors：

Lei Tao ¹ ,  Wang Runsheng ¹ , Li Juan ² , Pan Jingjing ³ , Li Peijun ¹ , Wang Jing ² , Wang Yi ⁴ , Zheng Yi ⁴ , Du Shanshuang ¹ , Lyu Peilin ¹

1. Department of Ophtalmology, Xi’an Fourth Hospital, Xi’an 710004, China;
2. Department of Neurology, Xi’an Fourth Hospital, Xi’an 710004, China;
3. Pharmacy Department, Xi’an Fourth Hospital, Xi’an 710004, China;
4. Intervention Department, Xi’an Fourth Hospital, Xi’an 710004, China;
Lyu Peilin is working on the Department of Ophtalmology, Xi’an First Hospital, Xi’an 710002, China;

Corresponding author：

Wang Runsheng, Email: wangrun-sheng0602@sohu.com

Keywords：

Retinal artery occlusion/drug therapy; Thrombolytic therapy; Hyaluronic acid; Ophthalmic artery obstruction; Facial injections

DOI：

10.3760/cma.j.issn.1005-1015.2019.06.015

Video：

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Objective To compare the clinical effects of urokinase thrombolytic therapy for optic artery occlusion (OAO) and retinal artery occlusion (RAO) caused by facial microinjection with hyaluronic acid and spontaneous RAO.Methods From January 2014 to February 2018, 22 eyes of 22 patients with OAO and RAO caused by facial microinjection of hyaluronic acid who received treatment in Xi'an Fourth Hospital were enrolled in this retrospective study (hyaluronic acid group). Twenty-two eyes of 22 patients with spontaneous RAO were selected as the control group. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logMAR visual acuity. FFA was used to measure arm-retinal circulation time (A-Rct) and filling time of retinal artery and its branches (FT). Meanwhile, MRI examination was performed. There were significant differences in age and FT between the two groups (t=14.840, 3.263; P=0.000, 0.003). The differecens of logMAR visual acuity, onset time and A-Rct were not statistically significant between the two groups (t=0.461, 0.107, 1.101; P=0.647, 0.915, 0.277). All patients underwent urokinase thrombolysis after exclusion of thrombolytic therapy. Among the patients in the hyaluronic acid group and control group, there were 6 patients of retrograde ophthalmic thrombolysis via the superior pulchlear artery, 6 patients of retrograde ophthalmic thrombolysis via the internal carotid artery, and 10 patients of intravenous thrombolysis. FFA was reviewed 24 h after treatment, and A-Rct and FT were recorded. Visual acuity was reviewed 30 days after treatment. The occurrence of adverse reactions during and after treatment were observed. The changes of logMAR visual acuity, A-Rct and FT before and after treatment were compared between the two groups using t-test.Results At 24 h after treatment, the A-Rct and FT of the hyaluronic acid group were 21.05±3.42 s and 5.05±2.52 s, which were significantly shorter than before treatment (t=4.569, 2.730; P=0.000, 0.000); the A-Rct and FT in the control group were 19.55±4.14 s and 2.55±0.91 s, which were significantly shorter than before treatment (t=4.114, 7.601; P=0.000, 0.000). There was no significant difference in A-Rct between the two groups at 24 h after treatment (t=1.311, P=0.197). The FT difference was statistically significant between the two groups at 24 h after treatment (t=4.382, P=0.000). There was no significant difference in the shortening time of A-Rct and FT between the two groups (t=0.330, 0.510; P=0.743, 0.613). At 30 days after treatment, the logMAR visual acuity in the hyaluronic acid group and the control group were 0.62±0.32 and 0.43±0.17, which were significantly higher than those before treatment (t=2.289, 5.169; P=0.029, 0.000). The difference of logMAR visual acuity between the two groups after treatment was statistically significant (t=2.872, P=0.008). The difference in logMAR visual acuity before and after treatment between the two groups was statistically significant (t=2.239, P=0.025). No ocular or systemic adverse reactions occurred during or after treatment in all patients. Conclusions Urokinase thrombolytic therapy for OAO and RAO caused by facial microinjection with hyaluronic acid and spontaneous RAO is safe and effective, with shortening A-Rct, FT and improving visual acuity. However, the improvement of visual acuity after treatment of OAO and RAO caused by facial microinjection with hyaluronic acid is worse than that of spontaneous RAO.

Citation： Lei Tao, Wang Runsheng, Li Juan, Pan Jingjing, Li Peijun, Wang Jing, Wang Yi, Zheng Yi, Du Shanshuang, Lyu Peilin. Effect of urokinase thrombolytic therapy for optic artery and retinal artery occlusion caused by facial microinjection with hyaluronic acid and spontaneous retinal artery occlusion. Chinese Journal of Ocular Fundus Diseases, 2019, 35(6): 593-598. doi: 10.3760/cma.j.issn.1005-1015.2019.06.015 Copy

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1. 贺茂林.脑血管病[M]//贾建平.神经病学.北京: 人民卫生出版社, 2014: 170-183.He ML. Cerebrovascular disease[M]//Jia JP. Neurology. Beijing: People's Medical Publishing House, 2014: 170-183.
2. Wang R, Qian L, Wang Y, et al. Evaluation of ophthalmic artery branch retrograde intervention in the treatment of central retinal artery occlusion (CRAO)[J]. Med Sci Monit, 2017, 23: 114-120. DOI: 10.12659/MSM.898352.
3. Funt D, Pavicic T. Dermal fillers in aesthetics: an overview of adverse events and treatment approaches[J]. Plast Surg Nurs, 2015, 35(1): 13-32. DOI: 10.1097/PSN.0000000000000087.
4. De Boulle K, Heydenrych I. Patient factors influencing dermal filler complications: prevention, assessment, and treatment[J]. Clin Cosmet Investig Dermatol, 2015, 8: 205-214. DOI: 10.2147/CCID.S80446.
5. Tansatit T, Apinuntrum P, Phetudom T. An anatomic basis for treatment of retinal artery occlusions caused by hyaluronic acid injections: a cadaveric study[J]. Aesthetic Plast Surg, 2014, 38(6): 1131-1137. DOI: 10.1007/s00266-014-0408-1.
6. 王润生, 钱露, 王毅, 等. 眼动脉分支逆行介入溶栓治疗视网膜中央动脉阻塞疗效观察[J]. 中华眼底病杂志, 2016, 32(4): 377-381. DOI: 10.3760/cma.j.issn.1005-1015.2016.04.008.Wang RS, Qian L, Wang Y, et al. Ophthalmic artery branch retrograde interventional therapy for central retinal artery occlusion[J]. Chin J Ocul Fundus Dis, 2016, 32(4): 377-381. DOI: 10.3760/cma.j.issn.1005-1015.2016.04.008.
7. 王润生, 雷涛, 王毅, 等. 超选择性眼动脉及选择性颈内动脉溶栓治疗视网膜中央动脉阻塞的疗效观察[J]. 中华眼底病杂志, 2014, 30(5): 450-453. DOI: 10.3760/cma.j.issn.1005-1015.2014.05.005.Wang RS, Lei T, Wang Y, et al. Super-selective ophthalmic artery or selective carotid artery thrombolytic therapy for central retinal artery occlusion[J]. Chill J Ocal Fundus Dis, 2014, 30(5): 450-453. DOI: 10.3760/cma.j.issn.1005-1015.2014.05.005.
8. 王润生, 吕沛霖, 张娅萍, 等. 以尿激酶静脉溶栓为主治疗视网膜中央动脉阻塞115例临床疗效观察[J]. 中华眼底病杂志, 2012, 28(5): 466-471. DOI: 10.3760/cma.j.issn.1005-1015.2012.05.009.Wang RS, Lv PL, Zhang YP, et al. Intravenous thrombolysis with urokinase for central retinal artery occlusion in 115 patients[J]. Chin J Ocul Fundus Dis, 2012, 28(5): 466-471. DOI: 10.3760/cma.j.issn.1005-1015.2012.05.009.
9. Edwards PC, Fantasia JE. Review of long-term adverse effects associated with the use of chemically-modified animal and nonanimal source hyaluronic acid dermal fillers[J]. Clin Interv Aging, 2007, 2(4): 509-519.
10. Buhren BA, Schrumpf H, Hoff NP, et al. Hyaluronidase: from clinical applications to molecular and cellular mechanisms[J]. Eur J Med Res, 2016, 21: 5. DOI: 10.1186/s40001-016-0201-5.
11. Chou CC, Chen HH, Tsai YY, et al. Choroid vascular occlusion and ischemic optic neuropathy after facial calcium hydroxyapatite injection- a case report[J]. BMC Surg, 2015, 15: 21. DOI: 10.1186/s12893-015-0007-3.
12. Bravo BS, Rocha CR, Bastos JT, et al. Comprehensive treatment of periorbital region with hyaluronic acid[J]. J Clin Aesthet Dermatol, 2015, 8(6): 30-35.
13. Hu XZ, Hu JY, Wu PS, et al. Posterior ciliary artery occlusion caused by hyaluronic acid injections into the forehead: a case report[J]. Medicine (Baltimore), 2016, 95(11): 3124. DOI: 10.1097/MD.0000000000003124.
14. Chen Y, Wang W, Li J, et al. Fundus artery occlusion caused by cosmetic facial injections[J]. Chin Med J (Engl), 2014, 127(8): 1434-1437.
15. Kim YK, Jung C, Woo SJ, et al. Cerebral angiographic findings of cosmetic facial filler-related ophthalmic and retinal artery occlusion[J]. J Korean Med Sci, 2015, 30(12): 1847-1855. DOI: 10.3346/jkms.2015.30.12.1847.
16. Souza FBB, De Almeida Balassiano LK, Roos MDRC, et al. Delayed-type necrosis after soft-tissue augmentation with hyaluronic acid[J]. J Clin Aesthet Dermatol, 2015, 8(12): 42-47.

Chinese Journal of Ocular Fundus Diseases

Effect of urokinase thrombolytic therapy for optic artery and retinal artery occlusion caused by facial microinjection with hyaluronic acid and spontaneous retinal artery occlusion

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