面部美容注射后眼动脉及脑动脉阻塞的临床特征分析  

Analysis of clinical features of ophthalmic and cerebral artery occlusion after facial cosmetic injection

作　　者：王润生[1] 雷涛[1] 王毅[2] 郑轶[2] 杜善双[1] 乔秋博 杨云鹏[3] 韦君丽[3] Wang Runsheng;Lei Tao;Wang Yi;Zheng Yi;Du Shanshuang;Qiao Qiubo;Yang Yunpeng;Wei Junli(Department of Ophtalmology,The Fourth Hospital of Xi’an,Xi’an 710004,China;Intervention Department,The Fourth Hospital of Xi’an,Xi’an 710004,China;Department of Neurology,The Fourth Hospital of Xi’an,Xi’an 710004,China)

机构地区：[1]西安市第四医院眼科,710004 [2]西安市第四医院介入科,710004 [3]西安市第四医院神经内科,710004

出　　处：《中华眼底病杂志》2019年第5期470-474,共5页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的观察面部美容注射后发生眼动脉及脑动脉阻塞患者的临床特征。方法回顾性病例研究。2014年2月至2016年12月西安市第四医院眼科收治的面部美容注射后眼动脉及脑动脉阻塞患者20例20只眼纳入研究。其中,女性18例18只眼,男性2例2只眼。平均年龄(29.8±1.4)岁。就诊时间3.5~480.0 h,就诊中位数时间40 h。均于院外美容机构进行面部美容注射;注射后1~10 min出现视力障碍伴眼眶疼痛。右眼12例12只眼,左眼8例8只眼。注射材料,玻尿酸、自体脂肪分别为18、2例。注射部位,双颞部13例、鼻部4例、额部3例。注射填充剂浓度及剂量不详。均行视力、裂隙灯显微镜、眼底彩色照相、视野、FFA、OCT检查,以及颅脑CT、磁共振血管成像(MRA)检查。结果患眼视力无光感~0.6。20只眼中,单纯眼动脉阻塞3只眼(15%);眼动脉阻塞合并脑动脉阻塞4只眼(20%)、眼动脉眼肌动脉阻塞1只眼(5%);单纯视网膜动脉阻塞(RAO)7只眼(35%),其中视网膜中央动脉(CRAO)、半侧动脉、分支动脉阻塞分别为4、1、2只眼;CRAO伴睫状后长动脉阻塞1只眼(5%);睫状后长动脉阻塞伴缺血性视神经病变1只眼(5%);CRAO合并鼻背动脉阻塞2只眼(10%);CRAO、睫状后长动脉阻塞合并右大脑中动脉阻塞1只眼(5%)。20例中,眼球运动障碍和眼睑皮肤发绀4例(20%);合并面部疼痛、鼻部皮肤缺血坏死2例(10%)。MRA检查发现颅内新发缺血灶6例(30%)。其中,玻尿酸注射5例,表现为无症状的小血管栓塞;自体脂肪注射1例,表现为眼动脉阻塞、脑动脉阻塞,同侧眼视力无光感、眼球运动障碍伴对侧肢体偏瘫。结论面部美容注射可并发RAO、睫状动脉阻塞、缺血性视神经病变、眼动脉阻塞、脑动脉阻塞等严重的医源性并发症。Objective To observe the clinical characteristics of ophthalmic and cerebral artery occlusion after facial cosmetic injection. Methods A retrospective case study. Twenty patients (20 eyes) with ophthalmic and cerebral artery occlusion in Department of Ophtalmology, The Fourth Hospital of Xi’an from February 2014 to December 2016 were enrolled in this study. There were 2 males (2 eyes) and 18 females (18 eyes). They aged from 21 to 41 years, with the mean age of 29.8±1.4 years. The disease courses was ranged from 3.5 hours to 21 days, with the mean of 40 hours. Facial cosmetic injections of all patients were performed at out-of-hospital beauty institutions. The visual impairment was associated with eyelid pain 1 to 10 minutes after injection.There were 12 right eyes and 8 left eyes.The injection materials, 18 patients were hyaluronic acid and 2 patients were autologous fat, respectively. At the injection site, 13 patients were sacral, 4 patients were nasal, and 3 patients were frontal. The concentration and dose of the injected filler were not known. All patients underwent vision, slit lamp microscope, fundus color photography, visual field, FFA, OCT, and brain CT, magnetic resonance angiography (MRA) examination. Results The visual acuity was ranged from no light perception to 1.0. Among the 20 eyes, 3 eyes (15%) were obstructed by simple ophthalmic artery;5 eyes (25%) were obstructed by ophthalmic artery combined with cerebral artery;7 eyes (35%) were obstructed by simple retinal artery occlusion (RAO) alone, which including central RAO (CRAO, 4 eyes), hemi-lateral artery obstruction (1 eye) and branch RAO (2 eyes);1 eye (5%) was CRAO with ciliary artery branch obstruction;1 eye (5%) was branch artery occlusion with ischemic optic neuropathy;2 eyes (10%) were CRAO with nasal dorsal artery occlusion;1 eye (5%) was CRAO, posterior ciliary artery obstruction and right middle cerebral artery occlusion. Among 20 patients, 4 patients (20%) had eye movement disorder and eyelid skin bun;2 patients (10%) had facial pa

关 键 词：视网膜动脉闭塞 睫状动脉闭塞 脑动脉闭塞 面部注射美容术 

分 类 号：R77[医药卫生—眼科]