Pathophysiology Study of Filler-Induced Blindness

Area of Science:

• Ophthalmology
• Plastic Surgery
• Anatomy

Background:

• Retrograde arterial embolism is a proposed mechanism for filler-induced blindness.
• No prior human studies have confirmed this mechanism.

Purpose of the Study:

• To investigate the pathophysiology of filler-induced blindness.
• To simulate filler embolism using a fresh cadaver perfusion model.

Main Methods:

• A fresh cadaver head perfusion model was utilized, simulating physiologic blood pressure and flow rates.
• Hyaluronic acid filler, mixed with methylene blue, was injected into the supratrochlear artery.
• Techniques included cadaver dissection, angiographic study, and histology.

Main Results:

• Successful cannulation of the supratrochlear artery was achieved in all six cadavers.
• Ophthalmic artery emboli were demonstrated in three cadavers.
• Angiography confirmed filler emboli in the ophthalmic artery, showing a cut-off sign.

Conclusions:

• Retrograde hyaluronic acid filler emboli to the ophthalmic artery can be created by cannulating the supratrochlear artery.
• The superficial location and rich vasculature of the supratrochlear artery contribute to this risk.
• This cadaveric study substantiates retrograde arterial embolism as a cause of filler-induced blindness.