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Study of the pathophysiology of filler-induced blindness
Kihyun Cho, MD, MSc; Edoardo Dalla Pozza, MD; Bahar Bassiri Gharb, MD, PhD; Gabor Toth, MD; James E. Zins, MD
Cleveland Clinic Foundation, Department of Plastic Surgery
2017-02-20
Presenter: Kihyun Cho
Affidavit:
This project is the original work of the research fellow
Director Name: Bahar Bassiri Gharb, MD, PhD
Author Category: Fellow Plastic Surgery
Presentation Category: Basic Science Research
Abstract Category: Aesthetics
Background: Many authors have proposed retrograde arterial embolism of filler as the responsible mechanism for filler-induced blindness. However, no previous human study has been done to prove this proposed mechanism.
Objective: To investigate the pathophysiology of filler-induced blindness using a fresh cadaver perfusion technique.
Methods: Our laboratory has established a fresh cadaveric head perfusion model that simulates both physiologic blood pressure and flow rate of the carotid artery, ophthalmic artery, supratrochlear artery. The common carotid artery and the vertebral artery was exposed to allow cannulation and the jugular vein was exposed for open venous drainage. A perfusion system consisting of a centrifugal pump, pressure monitor was connected to the catheter. The plasma based perfusate was circulated through the cadaveric head. Color Doppler sonography was used to measure the flow velocity of the ophthalmic artery, supratrochlear artery. The hyaluronic acid filler mixed with methylene blue was injected into the cannulated cutaneous branch of the supratrochlear artery. Angiogram in the arterial system was used to investigate the filler-induced blindness.
Result: Embolism in the ophthalmic artery was successfully demonstrated in the two fresh cadaveric head perfusion model. 0.07 ml and 0.05 ml of hyaluronic acid filler were enough to create emboli. The C-arm angiogram in the arterial system showed cut-off sign in the ophthalmic artery due to embolism created by hyaluronic acid filler.
Conclusion: Our study demonstrated the retrograde arterial embolism of filler as the responsible mechanism for filler-induced blindness. Future studies will further document what we have found in our preliminary study.
