Soft-tissue Filler–associated Blindness: A Systematic Review of Case Reports and Case Series

April 7, 2019

By Vandana Chatrath, MSc,*† Pooja S. Banerjee, MPharm,‡ Greg J. Goodman, MD, FACD,§ and Eqram Rahman, MBBS, MS, PhD¶

Background:

With the increase in the use of soft-tissue fillers worldwide, there has been a rise in the serious adverse events such as vascular compromise and blindness. This article aims to review the role of fillers in causing blindness and the association between hyaluronic acid (HA) filler and blindness.

Methods:

The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were used to report this review.

Results:

A total of 190 cases of blindness due to soft-tissue fillers were identified, of which 90 (47%) cases were attributed to autologous fat alone, and 53 (28%) cases were caused by HA. The rest of the cases were attributed to collagen, calcium hydroxylapatite, and other fillers.

Conclusions:

Autologous fat was the most common filler associated with blindness despite HA fillers being the most commonly used across the globe. However, the blindness caused by other soft-tissue fillers like collagen and calcium hydroxylapatite was represented. It was also evident through the review that the treatment of HA-related blindness was likely to have better outcomes compared with other fillers due to hyaluronidase use.

“Beauty” is a universal phenomenon that transcends geographical boundaries and cultures. Its occurrence or attainment influences self-confidence, improves psychological standing, and elevates personal and professional capabilities.1 Minimally invasive cosmetic procedures have increased relative to other aspects of cosmetic surgery due to its advantages of achieving a subtle natural appearance, restoring natural contour, reducing morbidity, requiring less downtime posttreatment, and the easy availability of these procedures.2

A plethora of soft-tissue fillers for facial aesthetic correction ranging from autologous fat, polymethylmethacrylate, calcium hydroxylapatite, poly-L-Lactic acid, polycaprolactone, and hyaluronic acid (HA) are available. Of these, HA is the most widely used filler (over 2 million) with the longevity of approximately 6–24 months depending on the molecular size, a method of cross-linking, and the region of injection.3 Fillers have been traditionally associated with mild and transient adverse events such as bruising, swelling, infection, and surface irregularities. However, with the increased use of fillers worldwide, more serious and permanent adverse events such as vascular compromise and blindness are on the rise.4 Vision loss is a rare adverse event but catastrophic to both patient and the physician.5

With the increase in the availability of the soft-tissue fillers, number of aesthetic practitioners, and demand for aesthetic procedures globally, the usage of fillers is expected to rise. It is imperative that aesthetic physicians have a firm knowledge of the vascular anatomy and understand potential complications, critical prevention, and management strategies.6,7

The present systematic review has been conducted to elucidate the occurrence of blindness with various soft-tissue fillers, the association between HA filler and blindness, and to review factors influencing the development of blindness. We aim to fill in the gap between the existing practice and knowledge about the adverse effect of blindness in relation to the use of soft-tissue fillers, so that clinicians can make evidence-based decisions.

Source:https://www.researchgate.net/publication/332236589_Soft-ti