最近一期的醫學雜誌，發表了關於注射人工植入物，造成眼動脈阻塞，導致失明的文章，跟大家分享一下
LONDON — Some patients who get facial injections to look good may end up seeing very poorly as a result of retrograde occlusion of ocular arteries, warn researchers.
"The risk of complications is higher when injections are made to the area supplied by the dorsal nasal and supratrochlear arteries, and when the injections are performed by inexperienced or noncertified personnel," said Tharikarn Sujirakul, MD, a research fellow in ophthalmology at Columbia University College of Physicians and Surgeons in New York City.
注射填充物造成失明的狀況，最常發生在dorsal nasal and supratrochlear arteries，簡言之，就是在鼻子的山根附近的區域。而紐約市哥倫比亞大學眼科研究員醫師，認為這些狀況是發生在一些沒有經驗的醫師，或甚至是根本沒有醫師資格的人手上。
Reporting here at the 14th EURETINA Congress, Dr. Sujirakul described six patients who received dermal filler injections in their faces with either hydrophilic gel, collagen, silicone, or an unknown material and developed retrograde arterial occlusions, causing either temporary or permanent vision loss in one eye.
Dermal filler injections are common procedures that are increasing in popularity in aesthetic practice because they are minimally invasive, can be performed simply and quickly, and generally have predictable outcomes ― at least for dermatologic purposes, Dr. Sujirakul pointed out.
Her team reported results from a small observational series of patients who presented with acute vision loss to one of two university-based hospitals in New York City.
Beauty in the Eye of the Beholder
醫學會上，這位醫師收集了六個這樣的個案，分別是注射玻尿酸、微晶磁、膠原蛋白、矽膠、甚至一些不知名的物質。四位個案分別是注射在山根，一位是額頭、一位是太陽穴。其中三位注射在山根部位的個案，產生了視神經的缺血病變，而造成嚴重的視力缺損。另外三位甚至更嚴重，還造成了其他位置的動脈阻塞，甚至是腦內的血管。
Four of the patients had injections at the nasal bridge, one in the forehead, and one in the temporal fossa. Three of the patients ― a 31-year old man, a 20-year-old woman, and a 26-year-old woman ― presented with symptoms that included lid swelling, ptosis, proptosis, and in two cases, relative afferent pupillary defects.
These patients were found to have occlusion of the posterior ciliary artery with anterior ischemic optic neuropathy. All three had had injections in the nasal bridge. Visual acuities ranged from 20/25 to 20/200.
A fourth patient, a 20-year-old man, presented with afferent pupillary defects, and had multiple branch retinal artery occlusions, with a visual acuity of 20/200. The remaining two patients had occlusion of the ophthalmic artery, and one also had occlusion of the middle cerebral artery. Each of these patients had no light perception in the affected eye.
At follow-up, of the three patients with posterior ciliary artery occlusion, two (20/30 and 20/200 at presentation) had recovery to 20/20, but for one patient, vision deteriorated from 20/25 to 20/40.
The patient with multiple branch retinal artery occlusions had partial visual improvement, from 20/200 at presentation to 20/60 at follow-up, but the two patients with ophthalmic artery occlusions had apparently permanent visual loss in their affected eyes.
The findings indicate that visual prognosis depends on the affected artery, Dr. Sujirakul said.
前三位個案，有兩位後來的視力有恢復正常，有一位還是有些視力損失。最後兩位個案，眼動脈完全阻塞者，則造成了永久性的視力損失。醫師認為，視力的恢復與否，與阻塞的動脈及程度有絕對的關係。
"These are really terrible side effects," commented Tersio Avitabile, MD, professor of ophthahlmology at the University of Catania, Italy. Dr. Avitabile was comoderator of the session in which the data were presented, but he was not involved in the study.
In an interview with Medscape Medical News, Dr. Avitabile said that because the patients presented spontaneously, the actual incidence of ocular arterial occlusion is not known. Nonetheless, because the occlusions occurred following an elective, medically unnecessary procedure, such potentially devastating visual consequences are unacceptable.
Dr. Sujirakul and Dr. Avitabile have reported no relevant financial relationships.
14th EURETINA Congress. Abstract presented September 12, 2014.
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