对于与注射软组织填充物相关的视力丧失的管理,提出了多种治疗策略。目前,对于软组织填充物引起的视力丧失(STFIVL)的即时治疗,目前尚无国际公认的共识.最近的文献系统综述得出结论,没有足够的证据支持球后透明质酸酶,和替代疗法需要探索。现有文献表明,球后和球周透明质酸酶在逆转软填充剂诱导的视力丧失方面的成功不一致且未经证实。已使用各种疗法来帮助视力丧失的逆转,但具有混合的结果。目前的证据基础不支持使用球后和球周透明质酸酶。使用球后透明质酸酶逆转软组织填充物引起的视力丧失是有争议的。其疗效仍未得到证实,文献中有混合证据。目前的证据表明,引入与球后透明质酸酶相关的严重不良事件的风险可能增加,甚至可能加剧那些未经眼科培训的临床医生的问题。因此,我们为眼科和非眼科医师推荐两种替代治疗途径.本出版物的建议目标是了解STFIVL的病理生理学,识别体征和症状,并提出算法来管理非眼科和眼科培训的临床医生的视力丧失。临床医生必须迅速采取行动,并安排立即转移到急诊科或眼科专家设置,为患者提供最佳的视力恢复机会。非眼科培训的临床医生的任何干预的重点都应基于立即使用非侵入性技术。
There are multiple treatment strategies proposed for the management of vision loss related to the injection of soft tissue fillers. Currently, there is no internationally accepted
consensus on the immediate management of soft tissue filler induced vision loss (STFIVL). A recent systematic review of the literature concluded that there is not enough evidence to support retrobulbar hyaluronidase, and alternative treatments require exploration. The available literature demonstrates the inconsistent and unproven success of retrobulbar and peribulbar hyaluronidase in reversal of soft filler induced vision loss. Various therapeutics have been used to aid the reversal of vision loss but with mixed outcomes. The current evidence base does not support the use of retrobulbar and peribulbar hyaluronidase. The use of retrobulbar hyaluronidase for reversing soft tissue filler induced vision loss is controversial. Its efficacy remains unproven and there is mixed evidence within the literature. The current evidence suggests that there may be an increased risk of introducing severe adverse events associated with retrobulbar hyaluronidase and may even exacerbate the problem for those clinicians who are not ophthalmology trained. Therefore, we recommend two alternative treatment pathways for ophthalmology and non-ophthalmology trained practitioners. The suggested goal of this publication is to understand the pathophysiology of STFIVL, recognize signs and symptoms, and to propose algorithms to manage vision loss for both non-ophthalmology and ophthalmology trained clinicians. Clinicians must act swiftly and arrange immediate transfer to an emergency department or ophthalmology specialist setting to give the patient the best chance of vision restoration. The focus of any intervention for non-ophthalmology trained clinicians should be based around the immediate use of non-invasive techniques.