New Study Confirms Pathophysiology of Filler-Induced Blindness

supratrochlear artery

A team of researchers used a fresh cadaver perfusion technique to substantiate whether arterial embolism is responsible for hyaluronic acid-induced blindness. Working with a fresh cadaver head perfusion model that simulates both physiologic blood pressure and flow rate of the carotid artery, ophthalmic artery and supratrochlear artery, Ki-Hyun Cho, MD, MSc, et al, cannulated the carotid artery and exposed the internal jugular vein for open venous drainage. While plasma-based perfusate circulated through the cadaver head, they injected a hyaluronic acid filler mixed with methylene blue into the cannulated superficial branch of the supratrochlear artery. Cadaver dissection, angiographic study and histology were used to investigate filler-induced blindness.

In all six cadavers, they successfully cannulated the superficial branch of the supratrochlear. In three of the six heads, a cut-off sign in the ophthalmic artery due to hyaluronic acid filler emboli was documented by the C-arm angiogram. “Our cadaveric study demonstrated that retrograde hyaluronic acid filler emboli to the ophthalmic artery could be produced by the cannulation of the supratrochlear artery,” the authors wrote. “The superficial location of the supratrochlear artery, the rich vasculature surrounding it, and the variability in the anatomy make this possible.”

The study was published in Aesthetic Surgery (January 2019).

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