Long-Term Prognosis of Vision Loss Caused by Facial Hyaluronic Acid Injections and the Potential Approaches to Address this Catastrophic Event


 
 
 Vision loss is a serious complication of hyaluronic acid filler injections, and long-term observations regarding the prognosis, particularly with angiography, is rare.
 
 
 
 This study aimed to investigate the long-term prognosis and living status of patients with visual defects due to hyaluronic acid filler injections.
 
 
 
 Nine patients with vision loss caused by hyaluronic acid filler injections and receiving different treatments were included and followed up for 2–6 years after the accident. Follow-ups, including outpatient ophthalmologic examinations, were performed in this study.
 
 
 
 In our follow-up observation, all patients had reintegrated into society and work. The prognosis was similar for all hyaluronidase treatments, including retrobulbar injections and superselective ophthalmic artery thrombolysis. The facial appearance was not remarkably affected, and only three patients reported slight scarring. Ptosis disappeared in all the patients, and slight strabismus was found in five patients. However, vision improvement was very limited, even in the patients whose occluded retinal central artery received reperfusion.
 
 
 
 Our long-term follow-up showed that the patients with vision loss caused by hyaluronic acid filler injections could reintegrate into society after treatment. Although the embolization of the retinal central artery led to reperfusion, vision was not restored, which further demonstrated the difficulty of recovering vision with the current treatment and the importance of prophylaxis. In the future, we envision developing autohydrolysis HA by incorporating hyaluronidase-containing stimuli-responsive nanoparticles and a dual-pipe syringe to address this catastrophic event.
