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Following the language and exercise rehabilitation therapy for approximately three months, the visual acuity was still "non light perception (NLP)", but conjunctival oedema, hyposphagma, and external ophthalmoplegia showed signs of improvement. In addition, all of general symptoms including dysarthria, aphasia, and muscle weakness in the limbs disappeared.

 

However, due to the later change in ocular ischemia, the pupil of the left eye did not react to lights, and posterior synechiae of iris occurred. A fibrovascular tissue was also observed at the retina. The results of brain MRI made no big difference from those shown three months ago.

 

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Pathogenesis and Therapy Method of Blindness

 

If the filler material retrogrades to the distal portion of the central retinal artery, only localized skin complications will occur; but if the filler material retrogrades to the proximal portion of the central retinal artery, blindness is very highly likely to occur due to central retinal artery occlusion. The retrograde flow through the internal carotid artery may result in cerebral infarctions due to filler embolization.

 

As shown in the above case, blindness, which occurs as the filler material blocks the central retinal artery, is irreversible, because the central retinal artery is the end artery and there are no correct collateral arteries (The cillio-retinal artery has been found in 20% of patients, but in this case, only the central visual acuity was maintained.) Therefore, prevention is the most important and must be done thoroughly.

 

If prevention fails and then blindness occurs, an immediate treatment should be initiated. There has been no effective treatment for the blindness due to fillers. The only treatment available when blindness occurs due to hyaluronic acid fillers is the retrobulbar injection of hyaluronidase to dissolve and remove hyaluronic acid fillers.

 

Its efficacy was partly verified in an animal study in which the author participated. For this reason, only the hyaluronic acid fillers must be used around the eyes because they can be dissolved.

 

- To be continued