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Background <p>As the popularity of non-hyaluronic acid (HA) injectables such as biostimulators rise in medical aesthetics, so have the rates of complications related to these injectables, including that of iatrogenic visual loss from vascular occlusion.</p> Methods <p>The authors conducted a systematic review of the available literature on visual loss related to the most widely used biostimulator injectables including calcium hydroxylapatite (CaHA), polycaprolactone (PCL), poly-L-lactic acid (PLLA), and poly-D,L-lactic acid (PDLLA) to provide a report on the incidence of such events, as well as evidence-based management protocols.</p> Results <p>CaHA has at least 11 published cases of vascular occlusion causing visual impairment, most involving the nasal dorsum. PLLA has two confirmed reports of visual loss, one from injection to periorbital/nasal region, and another from injection to the temple. PDLLA- carboxy-methylcellulose (CMC) has two reported cases of visual loss, one from injection to the forehead, another from injection to glabella region. PDLLA-HA has one reported case of visual loss from posterior ischemic optic neuropathy (PION). PCL has no published cases of blindness but one case of facial artery embolism. An evidence-based management protocol includes a sound knowledge of anatomy and injectable characteristics, timely recognition of symptoms, immediate actions such as starting intraocular lowering agents and sending to the ophthalmologist, as well as supportive therapy such as hyperbaric oxygen, anti-inflammatory and anti-coagulation therapy.</p> Conclusions <p>Our review and proposed management protocol is timely in guiding physicians of the recognition and management of vascular occlusion causing visual loss by biostimulator injectables, especially in a time of rising popularity of these injectables in medical aesthetics.</p> Level of Evidence V <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors <a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>

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Visual Loss in Biostimulator Injectables: A Review of Incidence, Risk Factors, Etiology and Management Proposal

  • 期刊论文

  • 发表日期：

    2025年11月20日

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  • Stephanie M. Young,
  • Alice S. C. Goh,
  • Preethi Jeyabal,
  • Adrian S. H. Ooi

摘要

Background

As the popularity of non-hyaluronic acid (HA) injectables such as biostimulators rise in medical aesthetics, so have the rates of complications related to these injectables, including that of iatrogenic visual loss from vascular occlusion.

Methods

The authors conducted a systematic review of the available literature on visual loss related to the most widely used biostimulator injectables including calcium hydroxylapatite (CaHA), polycaprolactone (PCL), poly-L-lactic acid (PLLA), and poly-D,L-lactic acid (PDLLA) to provide a report on the incidence of such events, as well as evidence-based management protocols.

Results

CaHA has at least 11 published cases of vascular occlusion causing visual impairment, most involving the nasal dorsum. PLLA has two confirmed reports of visual loss, one from injection to periorbital/nasal region, and another from injection to the temple. PDLLA- carboxy-methylcellulose (CMC) has two reported cases of visual loss, one from injection to the forehead, another from injection to glabella region. PDLLA-HA has one reported case of visual loss from posterior ischemic optic neuropathy (PION). PCL has no published cases of blindness but one case of facial artery embolism. An evidence-based management protocol includes a sound knowledge of anatomy and injectable characteristics, timely recognition of symptoms, immediate actions such as starting intraocular lowering agents and sending to the ophthalmologist, as well as supportive therapy such as hyperbaric oxygen, anti-inflammatory and anti-coagulation therapy.

Conclusions

Our review and proposed management protocol is timely in guiding physicians of the recognition and management of vascular occlusion causing visual loss by biostimulator injectables, especially in a time of rising popularity of these injectables in medical aesthetics.

Level of Evidence V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.