注射透明质酸引起视力受损及脑梗死病例分析  

Retinal artery occlusion and cerebral infarction caused by injection of hyaluronic acid:a clinical case analysis

作　　者：李春花[1] 马为梅[1] 王润生[1] 雷晓琴[1] 宋虎平[1] 周婷洁[2] 吕朋 柴芳[1] Li Chunhua;Ma Weimei;Wang Runsheng;Lei Xiaoqin;Song Huping;Zhou Tingjie;Lyu Peng;Chai Fang(Department of Ophthalmology,Xi'an No.4 Hospital,Xi'an 710004,China;Xi'an Center for Disease Control and Prevention,Xi'an 710054,China)

机构地区：[1]西安市第四医院眼科,710004 [2]西安市疾病预防控制中心,710054

出　　处：《中华医学美学美容杂志》2019年第6期452-455,共4页Chinese Journal of Medical Aesthetics and Cosmetology

基　　金：西安市第四医院科研孵化基金项目(FZ-23);2017年陕西省中医管理局中医药科学技术研究课题(JCMS061);陕西省科技厅社会发展科技攻关项目(2015SF232)。

摘　　要：目的分析面部注射透明质酸引起视网膜动脉阻塞甚至脑梗死的临床表现以及诊疗经过。方法收集2010年12月至2017年1月就诊于西安市第四医院眼科因面部注射透明质酸导致视力下降的女性患者15例15眼,年龄25~41岁,平均33.0岁。收集病史、治疗方法等临床资料,并随访1年。结果15例均为面部注射透明质酸,其中8例额部注射、3例眉间注射、3例鼻唇沟注射、1例左眼颞侧注射。均为注射后1~6 h出现视物不清并立即就医。检查后显示13例为视网膜中央动脉阻塞、1例为视网膜分支动脉阻塞、1例为缺血性视神经病变。13例视力无光感、1例视力0.6、1例视力指数/30 cm。14例伴有脑梗死,表现为头痛、头晕。住院后给予溶栓、营养支持等治疗,9例行介入溶栓术,治疗后11例视力无恢复,4例视力提高,头痛、头晕症状消失,但脑梗死病灶仍然存在。结论面部注射透明质酸后可发生视力下降及脑梗死,紧急治疗视力改善不明显,最终导致不可逆视力受损甚至丧失。Objective To summarize the clinical manifestations and treatment of retinal artery occlusion and cerebral infarction caused by facial injection of hyaluronic acid.Methods Fifteen cases(15 eyes)with vision lose caused by facial cosmetic injection of hyaluronic acid visited Xi'an No.4 Hospital from December 2010 to January 2017.The clinical data were collected such as general medical history and treatment methods,and follow-up for 1 year.Results All patients were female,22-41 years old,with average age of 33.All patients were injected with hyaluronic acid.For 8 patients the fillers were injected in the forehead,3 patients were in the glabellar region,3 patients were in the nasolabial fold,and 1 patient was in the temporal of left eye.All patients had vision lose after injection,the visiting time was 1 to 6 hours.13 patients were central retinal artery occlusion(CRAO).1 patient was retinal branch artery occlusion(BRAO),1 patient was ischemic optic neuropathy(ION),13 patients manifested as no light perception(NLP),1 patient was 0.6,1 patient was CF/30 cm,and 14 patients with cerebral infarction,manifested as headache,dizziness.All patients were given emergency treatment,and 9 patients had treated with interventional thrombolysis therapy.After treatment 11 patients,visual acuity had no significant improvement,but 4 patients improved.Headache,dizziness symptoms disappeared,but cerebral infarction lesions still existed on MRI.Conclusions Human face is a rich blood supply;vision loss and cerebral infarction could occur after injection of hyaluronic acid.After urgent treatment visual acuity is not improved obviously,eventually leading to irreversible visual impairment or even loss.

关 键 词：透明质酸 注射 视网膜动脉闭塞 脑梗死 

分 类 号：R74[医药卫生—神经病学与精神病学]