Reversal of Post-filler Vision Loss and Skin Ischaemia with High- Dose Pulsed Hyaluronidase Injections

Almond Wibowo • Krishan Mohan Kapoor Wolfgang G. Philipp-Dormston5

Buy article at https://link.springer.com/article/10.1007/s00266-019-01421-6

Case study – reversal of vision loss post HA filler.

• 40 year old woman in Indonesia
• Patient had 2ml of filler to nose
• Used a 25g cannula in nose
• Injected dorsum, columnella and tip
• 10 mins after treatment developed blurring of vision, blanching of nasal skinupper eye lid ptosis and pain in right eye
• After 1 hour patient had only perception of light in right eye
• Patient referred to hospital, doctors had no experience in this complication
• During her hospital stay she only received pain killers and IV fluids

At this point an experienced cosmetic physician was called to take over care of the patient.  40 hours post initial diagnosis, He began high dose pulsed hyaluronidase injection treatment.  He injected two doses of hyaluronidase around the ischemic area (nose, glab, cheek, forehead, with 1500 u Hyaluronidase).  6 hours later the second dose of 1500 u in the same area was injected (nose, glab, forehead, cheek).

On the fourth day there had been no improvement in the vision and some areas of necrosis had appeared externally. For the first time, 2 retrobulbar injections of hyaluronidase were injected (One superior 600u, one inferior 300u). At the same time 1500u was injected into the ischemic area externally (3rd dose externally in nose, glab, cheek, forehead).

On the fifth day another 1500 units was injected into the affected skin (4th external dose). Another retrobulbar injection of hyaluronidase was performed (900 units, one injection superior 600 u, one injection inferior 300u). Four hours later patient reported significant relief from pain in right eye.

On the sixth day another 1500 units hyaluronidase was injected into the affected skin and surrounding area (5thdose externally in nose, glab, cheek, forehead). Funduscopy showed no vascular obstruction.

Patient was monitored daily and gradually improved.  On the 21stday post filler normal movement of the eyelids was noticed.  Visual field had improved significantly.  

By 3 months post filler injection there was full recovery of vision and minimal scarring in multiple places from the ischemia.

This is a great paper you really need to read. Well done to the authors.  

You can buy the paper here Buy article at https://link.springer.com/article/10.1007/s00266-019-01421-6

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