1
|
Tao L, Wu Q, Wang J, Xu K, Yu G, Wan F, Qian H, Tang J. A patient with cerebral venous sinus thrombosis induced by facial hyaluronic acid injection. Ann Hematol 2020; 100:2403-2405. [PMID: 32388609 DOI: 10.1007/s00277-020-04038-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 04/10/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Liyuan Tao
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Qian Wu
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Jun Wang
- Key Lab of Modern Toxicology (NJMU), Ministry of Education; Department of Toxicology, School of Public Health, Nanjing Medical University, 818 Tianyuan East Road, Nanjing, 211166, Jiangsu, China
| | - Kangjing Xu
- Department of General Surgical, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Guoqin Yu
- Department of Neurology, Nanjing Jiangbei People's Hospital, 552 Geguan Road, Jiangbei New District, Nanjing, 210000, Jiangsu, China
| | - Fen Wan
- Department of Emergency, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Huiming Qian
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Jinrong Tang
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China.
| |
Collapse
|
2
|
Purgert RJ, Bala E. Cataract surgery in a patient with apparent sodium hyaluronate allergy. Can J Ophthalmol 2019; 54:e220-e221. [PMID: 31564358 DOI: 10.1016/j.jcjo.2018.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 11/19/2018] [Accepted: 11/21/2018] [Indexed: 11/19/2022]
Affiliation(s)
| | - Elisa Bala
- MetroHealth Hospital, Cleveland, OH; Case Western Reserve University, Cleveland, OH
| |
Collapse
|
3
|
Yao B, Shen F, Zhao X, Liu G, Ding Y. Ophthalmic artery occlusion combined with superior sagittal sinus thrombosis caused by hyaluronic acid injection for facial soft tissue augmentation: A case report. Medicine (Baltimore) 2019; 98:e17048. [PMID: 31490398 PMCID: PMC6738991 DOI: 10.1097/md.0000000000017048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Cosmetic hyaluronic acid injections for facial soft tissue augmentation are gaining popularity because of their convenience and favorable outcomes. Several associated complications have been described; however, ophthalmic artery occlusion (OAO) combined with superior sagittal sinus thrombosis (SSST) has been rarely reported. PATIENT CONCERNS A 21-year-old woman presented with sudden loss of vision and severe pain in the left eye, right upper limb weakness, and headache immediately after hyaluronic acid injection on the left side of her forehead. DIAGNOSIS Clinical manifestations and multimodal imaging, including spectral-domain optical coherence tomography, fundus fluorescein angiography, and digital subtraction angiography, indicated OAO and SSST. INTERVENTIONS Various clinical examinations were performed, and the patient was treated by thrombolysis, corticosteroids, oxygen therapy, a formula for the nourishment of the optic nerve, and measures for improving the microcirculation. OUTCOMES The treatment response was closely observed. The intracerebral hemorrhages were absorbed after 2 weeks of treatment, while the clinical manifestations, including ocular pain, headache, and limb dysfunction, were gradually alleviated. However, the visual acuity in the left eye remained at no light perception. LESSONS Cosmetic hyaluronic acid injection can result in emergent and catastrophic complications that require immediate treatment. Thus, the development of appropriate prevention and management protocols for such scenarios is considered crucial.
Collapse
Affiliation(s)
- Bangtao Yao
- Department of Ophthalmology, Lishui District People's Hospital, Nanjing, Jiangsu Province
| | - Feifei Shen
- Department of Neurology, Jiangsu province hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Xiaogui Zhao
- Department of Ophthalmology, Lishui District People's Hospital, Nanjing, Jiangsu Province
| | - Gang Liu
- Department of Ophthalmology, Lishui District People's Hospital, Nanjing, Jiangsu Province
| | - Yuhua Ding
- Department of Neurology, Jiangsu province hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| |
Collapse
|
4
|
Abstract
A 20-year-old woman presented with loss of vision in her right eye and a "black nose" after receiving hyaluronic acid filler injections in her right glabella 1 month prior. Her vision was no light perception, and external examination revealed resolving skin necrosis at the nasal tip. A dilated fundus exam showed a fibrotic membrane emanating from a pale optic nerve and a diffusely atrophic retina with sclerotic vessels. An MRI demonstrated scattered right-sided parietal lobe infarcts. These findings were consistent with inadvertent cannulation of the supraorbital artery, followed by injection of filler into the internal carotid circulation. The product traveled in a retrograde fashion, occluding the right ophthalmic artery, right dorsal nasal artery, and arterial segments to the Circle of Willis. This case highlights the importance of understanding the complex vascular architecture of the periorbita and the mechanism by which such occlusions occur.
Collapse
Affiliation(s)
- Zubair A Ansari
- a Department of Ophthalmology, University of Miami , Miami , FL , USA
| | - Catherine J Choi
- a Department of Ophthalmology, University of Miami , Miami , FL , USA
- b Ophthalmic Plastic Surgery, Bascom Palmer Eye Institute , Miami , FL , USA
| | - Andrew J Rong
- a Department of Ophthalmology, University of Miami , Miami , FL , USA
| | | | - David T Tse
- a Department of Ophthalmology, University of Miami , Miami , FL , USA
- b Ophthalmic Plastic Surgery, Bascom Palmer Eye Institute , Miami , FL , USA
| |
Collapse
|
5
|
Camargo CP, Frassei RD, Silva DIDSBCE, Pfann RZ, da Silva LDCM, Morais-Besteiro J, Gemperli R. Hyaluronic acid in tobacco-exposed rats. Inflammatory reaction, and duration of effect1. Acta Cir Bras 2019; 34:e201900202. [PMID: 30843935 PMCID: PMC6585909 DOI: 10.1590/s0102-8650201900202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/21/2018] [Accepted: 01/22/2019] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate the hyaluronic acid (HA) inflammatory reaction, fibroblasts, fibrosis and duration of effect in the dorsal region of tobacco-exposed rats. METHODS Ten Wistar rats were divided into two groups: tobacco-exposed-group (TEG;n=5) and air-control-group (CG;n=5). The TEG animals were tobacco-exposed twice a day, 30-minutes/session, during 60 days. After this period, all animals received 0.1 mL HA subcutaneous injection in the dorsal area. The volume of HA was measured immediately after HA injection and weekly using a hand-caliper in nine weeks. After this period, all the animals were euthanized, and a specimen of was collected to evaluate inflammatory cells, fibroblasts, and fibrosis by HE. RESULTS This study showed a higher inflammatory reaction in TEG than CG: inflammatory cell-count (CG: 1.07±0.9; TEG: 8.61±0.36, p<0.001); fibroblast count (CG: 2.92±0.17; TEG: 19.14±0.62, p<0.001), and fibrosis quantification (CG: 2.0; TEG: 3.75, p<0.001). The analysis of the HA volume in nine weeks in the dorsal region did not show a difference between groups (p=0.39). CONCLUSIONS This study suggested that the HA injection in the TEG caused an increase in inflammatory cell count, fibroblast, and fibrosis quantification when compared to the CG. There was no difference in the duration of effect of HA between the groups.
Collapse
Affiliation(s)
- Cristina Pires Camargo
- MD, Division of Plastic Surgery, Hospital das Clínicas, Laboratory
of Microsurgery and Plastic Surgery (LIM-04), Medical School, Universidade de São
Paulo (USP), Brazil. Intellectual and scientific content of the study,
interpretation of data, statistics analysis, manuscript writing, critical
revision
| | - Renan Dias Frassei
- Graduate student, Laboratory of Microsurgery and Plastic Surgery
(LIM-04), Medical School, USP, Sao Paulo-SP, Brazil. Acquisition, analysis and
interpretation of data; technical procedures
| | | | - Robert Zawadzki Pfann
- Graduate student, Laboratory of Microsurgery and Plastic Surgery
(LIM-04), Medical School, USP, Sao Paulo-SP, Brazil. Acquisition, analysis and
interpretation of data; technical procedures
| | - Luiza de Campos Moreira da Silva
- Graduate student, Laboratory of Microsurgery and Plastic Surgery
(LIM-04), Medical School, USP, Sao Paulo-SP, Brazil. Acquisition, analysis and
interpretation of data; technical procedures
| | - Julio Morais-Besteiro
- MD, Division of Plastic Surgery, Hospital das Clínicas, Laboratory
of Microsurgery and Plastic Surgery (LIM-04), Medical School, Universidade de São
Paulo (USP), Brazil. Intellectual and scientific content of the study,
interpretation of data, statistics analysis, manuscript writing, critical
revision
| | - Rolf Gemperli
- PhD, Division of Plastic Surgery, Hospital das Clínicas,
Laboratory of Microsurgery and Plastic Surgery (LIM-04), Medical School, USP, Sao
Paulo-SP, Brazil. Intellectual and scientific content of the study, interpretation
of data, critical revision
| |
Collapse
|
6
|
Abstract
This retrospective study investigated the efficacy and safety of extracorporeal shock wave (EPSW) combined with hyaluronic acid (HA) for patients with knee osteoarthritis (KOA).This retrospective study included 70 patients with KOA. Of those subjects, 35 of them received EPSW combined HA, and were allocated to a treatment group, while the other 35 participants received HA alone and were allocated to a control group. Patients in both groups were treated for a total of 8 weeks. The primary outcome was measured by visual analog scale (VAS). The secondary outcomes were measured by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and knee injury and osteoarthritis outcome score (KOOS). In addition, adverse events (AEs) were also evaluated. All outcomes were measured before and after the treatment.After the treatment, patients in the treatment group exhibited better efficacy in VAS (P < .01), WOMAC scale (pain, P < .01; function, P < .01; and stiffness, P < .01), and KOOS scores (pain, P < .01; function in daily living, P < .01; symptoms, P < .01; sport and recreation, P < .01; and quality of life, P < .01), than patients in the control group. In addition, no significant differences regarding the AEs were found between 2 groups.The findings of this study demonstrated that the efficacy of EPSW combined with HA is superior to the HA alone for patients with KOA.
Collapse
Affiliation(s)
| | | | - Qing-Xi Tang
- Department of Emergency Surgery, First Affiliated Hospital of Jiamusi University
| | - Xiao-Guang Li
- Department of Orthodonitics, Affiliated Stomatological Hospital of Jiamusi University, Jiamusi
| | - Jian-Hua Yang
- Department of Orthopedics, People's Hospital of Longgang District, Shenzhen, Guangdong, China
| | | | | | | |
Collapse
|
7
|
Hall MB, Roy S, Buckingham ED. Novel Use of a Volumizing Hyaluronic Acid Filler for Treatment of Infraorbital Hollows. JAMA FACIAL PLAST SU 2018; 20:367-372. [PMID: 29621374 PMCID: PMC6233621 DOI: 10.1001/jamafacial.2018.0230] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 01/15/2018] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Hyaluronic acid filler can be safely used as a soft-tissue filler for correction of infraorbital hollowing. It has a high overall patient satisfaction profile among patients. OBJECTIVE To report safety and patient satisfaction outcomes of Juvéderm Voluma XC for correction of infraorbital hollows. DESIGN, SETTING, AND PATIENTS This was a retrospective observational study performed at a private ambulatory facial plastic and reconstructive surgery practice. Participants were all patients 21 to 85 years old who presented to our practice and underwent Juvéderm Voluma XC treatment for correction of infraorbital hollows as a singular intervention from February 2016 to March 2017. INTERVENTIONS Injection of Juvéderm Voluma XC to the tear trough, nasojugal fold, and/or palpebromalar groove. MAIN OUTCOMES AND MEASURES Primary outcome measures include the number of recorded short- and long-term adverse events, need for additional treatment, and patient questionnaire FACE-Q scores. RESULTS A total of 202 eyes were treated in 101 patients with a mean follow-up of 12 months. Patients were principally female (90 [89%]) with an average age of 54 years (range, 21-85 years). Most patients (99) had Fitzpatrick grade 1 to 4 skin type (98%) and had an infraorbital hollows score of 2 to 4 (89 [88%]). The average initial treatment volume was 1 mL with 18 patients (18%) requiring additional treatment within 3 months. The average time until additional treatment was 35.7 days. Adverse effects include bruising (in 10 [10%], contour irregularities (2 [2%]), swelling (3 [3%]), and Tyndall effect (1 [1%]). Hyaluronidase was required in 3 patients (3%). Forty-one patients completed the FACE-Q Satisfaction With Eyes survey, and 42 patients completed the FACE-Q Satisfaction With Decision survey (41% and 42%). Overall mean (SD) patient satisfaction (based on FACE-Q scores) was 71.1% (27.3) and 65.6% (31.3), respectively. CONCLUSIONS AND RELEVANCE Juvéderm Voluma XC has a high patient satisfaction profile and an acceptable safety profile for the correction of infraorbital hollowing. LEVEL OF EVIDENCE 4.
Collapse
Affiliation(s)
| | - Sudeep Roy
- Buckingham Center for Facial Plastic Surgery, Austin, Texas
| | | |
Collapse
|
8
|
Two new intra-articular injections for knee osteoarthritis. Med Lett Drugs Ther 2018; 60:142-4. [PMID: 30133421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
|
9
|
Cooper C, Rannou F, Richette P, Bruyère O, Al‐Daghri N, Altman RD, Brandi ML, Collaud Basset S, Herrero‐Beaumont G, Migliore A, Pavelka K, Uebelhart D, Reginster J. Use of Intraarticular Hyaluronic Acid in the Management of Knee Osteoarthritis in Clinical Practice. Arthritis Care Res (Hoboken) 2017; 69:1287-1296. [PMID: 28118523 PMCID: PMC5432045 DOI: 10.1002/acr.23204] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 12/22/2016] [Accepted: 01/17/2017] [Indexed: 12/24/2022]
Affiliation(s)
- Cyrus Cooper
- University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK, and University of OxfordOxfordUK
| | - François Rannou
- AP‐HP Cochin Hospital, Universite Paris Descartes Sorbonne Paris Cite, and INSERM U1153ParisFrance
| | - Pascal Richette
- Universite Paris 7, UFR medicale, Assistance Publique‐Hôpitaux de Paris, and Hopital Lariboisière, INSERM U1132ParisFrance
| | | | | | - Roy D. Altman
- David Geffen School of Medicine, University of CaliforniaLos Angeles
| | | | | | | | | | - Karel Pavelka
- Institute of Rheumatology, Charles UniversityPragueCzech Republic
| | - Daniel Uebelhart
- Centre Hospitalier du Valais Romand, Centre Valaisan de PneumologieCrans‐MontanaSwitzerland
| | | |
Collapse
|
10
|
Abstract
The aim of this study is to describe the experience of 33 physicians, dermatologists and surgeons, with the use of a semi-cross-linked hyaluronic acid (HA) gel as a tear trough deformity filler within one month following injection, and to assess patient satisfaction with the procedure. This study is a case series conducted between February 2012 and December 2012 with the use of semi-cross-linked HA to correct tear trough deformity. The filler was administered in the preperiosteal tissues. The study involved case note review and a patient satisfaction survey. A total of 302 eyes of 151 patients were treated by 33 physicians, with a mean follow-up of 3 weeks. Patients were mainly female (86%), and middle-aged (mean age 48 years old). The gel was placed preperiosteally, deep to the orbicularis, anterior to the inferior orbital rim, with a mean volume of 0.48 ml per eye to achieve correction. The injection procedure was performed without local anesthetic for 79% of the patients. No serious adverse event was recorded. Side effects reported by investigators immediately after injection included bruising (11%), swelling (12%), and redness (inflammation 12%). Very few transitional blue discolorations (2.6%) were observed. No patient required dissolution with hyaluronidase. According to our satisfaction survey, all patients had cosmetic improvement. Most patients (97%) described marked or moderate satisfaction with the treatment. At one month, 18% requested additional hyaluronic acid gel for a touch-up injection. This case series confirms the effective use of a semi-cross-linked HA gel in tear trough rejuvenation. It has excellent patient tolerability, minimal complications, and excellent patient satisfaction.
Collapse
Affiliation(s)
- Marouen Berguiga
- a Department of Oculoplastic Surgery , Fondation Rothschild , Paris , France
| | - Olivier Galatoire
- a Department of Oculoplastic Surgery , Fondation Rothschild , Paris , France
| |
Collapse
|
11
|
Park DH, Chung JK, Seo DR, Lee SJ. Clinical Effects and Safety of 3% Diquafosol Ophthalmic Solution for Patients With Dry Eye After Cataract Surgery: A Randomized Controlled Trial. Am J Ophthalmol 2016; 163:122-131.e2. [PMID: 26685791 DOI: 10.1016/j.ajo.2015.12.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 12/03/2015] [Accepted: 12/03/2015] [Indexed: 12/19/2022]
Abstract
PURPOSE To compare the efficacies and safety profiles of 3% diquafosol and 0.1% sodium hyaluronate in patients with dry eye after cataract surgery. DESIGN Randomized controlled trial. METHODS setting: Soonchunhyang University Hospital, Seoul, South Korea. STUDY POPULATION In all, 130 eyes of 86 dry eye patients who had undergone cataract surgery between January 2014 and January 2015 were enrolled and randomly divided into a diquafosol group and a sodium hyaluronate group. INTERVENTION The diquafosol group used diquafosol 6 times a day and the hyaluronate group used sodium hyaluronate 6 times a day after cataract surgery. MAIN OUTCOME MEASURES Evaluations of efficacy were conducted based on an Ocular Surface Disease Index questionnaire, tear breakup time (TBUT), Schirmer I test, corneal fluorescein and conjunctival lissamine green staining scores, serial measurement of ocular higher-order aberrations (HOAs), corneal HOAs, and uncorrected distance visual acuity test. Safety evaluations were based on anterior chamber inflammation and discontinuation of the eye drops. RESULTS Objective signs and subjective symptoms were aggravated at 1 week postoperatively and began to recover significantly 4 weeks after surgery. The diquafosol group showed significantly superior TBUT (P < .001), corneal fluorescein (P = .045), and conjunctival staining (P = .001) compared to the sodium hyaluronate group throughout the study period. TBUT (P < .001) and the change in HOAs (P = .018) recovered significantly more quickly in the diquafosol group. The safety evaluations showed no intergroup differences. CONCLUSIONS Eye drops of 3% diquafosol may be an effective and safe treatment for the management of cataract surgery-induced dry eye aggravation in patients with preexisting dry eye.
Collapse
Affiliation(s)
- Dae Hyun Park
- Department of Ophthalmology, Soonchunhyang University College of Medicine, Soonchunhyang University Hospital, Seoul, South Korea
| | - Jin Kwon Chung
- Department of Ophthalmology, Soonchunhyang University College of Medicine, Soonchunhyang University Hospital, Seoul, South Korea.
| | - Du Ri Seo
- Department of Ophthalmology, Soonchunhyang University College of Medicine, Soonchunhyang University Hospital, Seoul, South Korea
| | - Sung Jin Lee
- Department of Ophthalmology, Soonchunhyang University College of Medicine, Soonchunhyang University Hospital, Seoul, South Korea
| |
Collapse
|
12
|
Affiliation(s)
- Seth S Leopold
- Clinical Orthopaedics and Related Research®, Philadelphia, PA, 19103, USA.
| |
Collapse
|
13
|
Affiliation(s)
- Y-C Lin
- From the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Department of Respiratory Therapy, and Hyperbaric Oxygen Therapy Center, China Medical University and China Medical University Hospital, Taichung 404, Taiwan
| | - W-C Chen
- From the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Department of Respiratory Therapy, and Hyperbaric Oxygen Therapy Center, China Medical University and China Medical University Hospital, Taichung 404, Taiwan
| | - W-C Liao
- From the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Department of Respiratory Therapy, and Hyperbaric Oxygen Therapy Center, China Medical University and China Medical University Hospital, Taichung 404, Taiwan
| | - T-C Hsia
- From the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Department of Respiratory Therapy, and Hyperbaric Oxygen Therapy Center, China Medical University and China Medical University Hospital, Taichung 404, Taiwan
| |
Collapse
|
14
|
Cohen JL, Biesman BS, Dayan SH, DeLorenzi C, Lambros VS, Nestor MS, Sadick N, Sykes J. Treatment of Hyaluronic Acid Filler-Induced Impending Necrosis With Hyaluronidase: Consensus Recommendations. Aesthet Surg J 2015; 35:844-9. [PMID: 25964629 DOI: 10.1093/asj/sjv018] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2014] [Indexed: 11/13/2022] Open
Abstract
Injection-induced necrosis is a rare but dreaded consequence of soft tissue augmentation with filler agents. It usually occurs as a result of injection of filler directly into an artery, but can also result from compression or injury. We provide recommendations on the use of hyaluronidase when vascular compromise is suspected. Consensus recommendations were developed by thorough discussion and debate amongst the authors at a roundtable meeting on Wednesday June 18, 2014 in Las Vegas, NV as well as significant ongoing written and verbal communications amongst the authors in the months prior to journal submission. All authors are experienced tertiary care providers. A prompt diagnosis and immediate treatment with high doses of hyaluronidase (at least 200 U) are critically important. It is not felt necessary to do a skin test in cases of impending necrosis. Some experts recommend dilution with saline to increase dispersion or lidocaine to aid vasodilation. Additional hyaluronidase should be injected if improvement is not seen within 60 minutes. A warm compress also aids vasodilation, and massage has been shown to help. Some experts advocate the use of nitroglycerin paste, although this area is controversial. Introducing an oral aspirin regimen should help prevent further clot formation due to vascular compromise. In our experience, patients who are diagnosed promptly and treated within 24 hours will usually have the best outcomes.
Collapse
Affiliation(s)
- Joel L Cohen
- Dr Cohen is an Associate Clinical Professor in the Department of Dermatology at the University of Colorado, Boulder, and an Assistant Clinical Professor in the Department of Dermatology at the University of California Irvine. Dr Biesman is a Clinical Assistant Professor in the Departments of Ophthalmology and Otolaryngology and the Division of Dermatology at Vanderbilt University Medical Center, Nashville, TN. Dr Dayan is a Clinical Assistant Professor in the Department of Otolaryngology at the University of Illinois, Chicago. Dr DeLorenzi is a plastic surgeon in private practice in Kitchener, Ontario, Canada. Dr Lambros is a Clinical Professor of Plastic Surgery at the University of California Irvine. Dr Nestor is a Voluntary Associate Professor in the Department of Dermatology and Cutaneous Surgery at the University of Miami Miller School of Medicine, FL. Dr Sadick is a Clinical Professor of Dermatology at Weill Cornell Medical College, New York, NY. Dr Sykes is a Professor and the Director of Facial Plastic Surgery in the Department of Otolaryngology at the UC Davis Health System of the University of California Davis, Sacramento
| | - Brian S Biesman
- Dr Cohen is an Associate Clinical Professor in the Department of Dermatology at the University of Colorado, Boulder, and an Assistant Clinical Professor in the Department of Dermatology at the University of California Irvine. Dr Biesman is a Clinical Assistant Professor in the Departments of Ophthalmology and Otolaryngology and the Division of Dermatology at Vanderbilt University Medical Center, Nashville, TN. Dr Dayan is a Clinical Assistant Professor in the Department of Otolaryngology at the University of Illinois, Chicago. Dr DeLorenzi is a plastic surgeon in private practice in Kitchener, Ontario, Canada. Dr Lambros is a Clinical Professor of Plastic Surgery at the University of California Irvine. Dr Nestor is a Voluntary Associate Professor in the Department of Dermatology and Cutaneous Surgery at the University of Miami Miller School of Medicine, FL. Dr Sadick is a Clinical Professor of Dermatology at Weill Cornell Medical College, New York, NY. Dr Sykes is a Professor and the Director of Facial Plastic Surgery in the Department of Otolaryngology at the UC Davis Health System of the University of California Davis, Sacramento
| | - Steven H Dayan
- Dr Cohen is an Associate Clinical Professor in the Department of Dermatology at the University of Colorado, Boulder, and an Assistant Clinical Professor in the Department of Dermatology at the University of California Irvine. Dr Biesman is a Clinical Assistant Professor in the Departments of Ophthalmology and Otolaryngology and the Division of Dermatology at Vanderbilt University Medical Center, Nashville, TN. Dr Dayan is a Clinical Assistant Professor in the Department of Otolaryngology at the University of Illinois, Chicago. Dr DeLorenzi is a plastic surgeon in private practice in Kitchener, Ontario, Canada. Dr Lambros is a Clinical Professor of Plastic Surgery at the University of California Irvine. Dr Nestor is a Voluntary Associate Professor in the Department of Dermatology and Cutaneous Surgery at the University of Miami Miller School of Medicine, FL. Dr Sadick is a Clinical Professor of Dermatology at Weill Cornell Medical College, New York, NY. Dr Sykes is a Professor and the Director of Facial Plastic Surgery in the Department of Otolaryngology at the UC Davis Health System of the University of California Davis, Sacramento
| | - Claudio DeLorenzi
- Dr Cohen is an Associate Clinical Professor in the Department of Dermatology at the University of Colorado, Boulder, and an Assistant Clinical Professor in the Department of Dermatology at the University of California Irvine. Dr Biesman is a Clinical Assistant Professor in the Departments of Ophthalmology and Otolaryngology and the Division of Dermatology at Vanderbilt University Medical Center, Nashville, TN. Dr Dayan is a Clinical Assistant Professor in the Department of Otolaryngology at the University of Illinois, Chicago. Dr DeLorenzi is a plastic surgeon in private practice in Kitchener, Ontario, Canada. Dr Lambros is a Clinical Professor of Plastic Surgery at the University of California Irvine. Dr Nestor is a Voluntary Associate Professor in the Department of Dermatology and Cutaneous Surgery at the University of Miami Miller School of Medicine, FL. Dr Sadick is a Clinical Professor of Dermatology at Weill Cornell Medical College, New York, NY. Dr Sykes is a Professor and the Director of Facial Plastic Surgery in the Department of Otolaryngology at the UC Davis Health System of the University of California Davis, Sacramento
| | - Val S Lambros
- Dr Cohen is an Associate Clinical Professor in the Department of Dermatology at the University of Colorado, Boulder, and an Assistant Clinical Professor in the Department of Dermatology at the University of California Irvine. Dr Biesman is a Clinical Assistant Professor in the Departments of Ophthalmology and Otolaryngology and the Division of Dermatology at Vanderbilt University Medical Center, Nashville, TN. Dr Dayan is a Clinical Assistant Professor in the Department of Otolaryngology at the University of Illinois, Chicago. Dr DeLorenzi is a plastic surgeon in private practice in Kitchener, Ontario, Canada. Dr Lambros is a Clinical Professor of Plastic Surgery at the University of California Irvine. Dr Nestor is a Voluntary Associate Professor in the Department of Dermatology and Cutaneous Surgery at the University of Miami Miller School of Medicine, FL. Dr Sadick is a Clinical Professor of Dermatology at Weill Cornell Medical College, New York, NY. Dr Sykes is a Professor and the Director of Facial Plastic Surgery in the Department of Otolaryngology at the UC Davis Health System of the University of California Davis, Sacramento
| | - Mark S Nestor
- Dr Cohen is an Associate Clinical Professor in the Department of Dermatology at the University of Colorado, Boulder, and an Assistant Clinical Professor in the Department of Dermatology at the University of California Irvine. Dr Biesman is a Clinical Assistant Professor in the Departments of Ophthalmology and Otolaryngology and the Division of Dermatology at Vanderbilt University Medical Center, Nashville, TN. Dr Dayan is a Clinical Assistant Professor in the Department of Otolaryngology at the University of Illinois, Chicago. Dr DeLorenzi is a plastic surgeon in private practice in Kitchener, Ontario, Canada. Dr Lambros is a Clinical Professor of Plastic Surgery at the University of California Irvine. Dr Nestor is a Voluntary Associate Professor in the Department of Dermatology and Cutaneous Surgery at the University of Miami Miller School of Medicine, FL. Dr Sadick is a Clinical Professor of Dermatology at Weill Cornell Medical College, New York, NY. Dr Sykes is a Professor and the Director of Facial Plastic Surgery in the Department of Otolaryngology at the UC Davis Health System of the University of California Davis, Sacramento
| | - Neil Sadick
- Dr Cohen is an Associate Clinical Professor in the Department of Dermatology at the University of Colorado, Boulder, and an Assistant Clinical Professor in the Department of Dermatology at the University of California Irvine. Dr Biesman is a Clinical Assistant Professor in the Departments of Ophthalmology and Otolaryngology and the Division of Dermatology at Vanderbilt University Medical Center, Nashville, TN. Dr Dayan is a Clinical Assistant Professor in the Department of Otolaryngology at the University of Illinois, Chicago. Dr DeLorenzi is a plastic surgeon in private practice in Kitchener, Ontario, Canada. Dr Lambros is a Clinical Professor of Plastic Surgery at the University of California Irvine. Dr Nestor is a Voluntary Associate Professor in the Department of Dermatology and Cutaneous Surgery at the University of Miami Miller School of Medicine, FL. Dr Sadick is a Clinical Professor of Dermatology at Weill Cornell Medical College, New York, NY. Dr Sykes is a Professor and the Director of Facial Plastic Surgery in the Department of Otolaryngology at the UC Davis Health System of the University of California Davis, Sacramento
| | - Jonathan Sykes
- Dr Cohen is an Associate Clinical Professor in the Department of Dermatology at the University of Colorado, Boulder, and an Assistant Clinical Professor in the Department of Dermatology at the University of California Irvine. Dr Biesman is a Clinical Assistant Professor in the Departments of Ophthalmology and Otolaryngology and the Division of Dermatology at Vanderbilt University Medical Center, Nashville, TN. Dr Dayan is a Clinical Assistant Professor in the Department of Otolaryngology at the University of Illinois, Chicago. Dr DeLorenzi is a plastic surgeon in private practice in Kitchener, Ontario, Canada. Dr Lambros is a Clinical Professor of Plastic Surgery at the University of California Irvine. Dr Nestor is a Voluntary Associate Professor in the Department of Dermatology and Cutaneous Surgery at the University of Miami Miller School of Medicine, FL. Dr Sadick is a Clinical Professor of Dermatology at Weill Cornell Medical College, New York, NY. Dr Sykes is a Professor and the Director of Facial Plastic Surgery in the Department of Otolaryngology at the UC Davis Health System of the University of California Davis, Sacramento
| |
Collapse
|
15
|
Abstract
The use of hyaluronic acid fillers for treatment of rhytides (wrinkles) is widespread in aesthetic dermatology and is considered a safe procedure; however, complications can occur especially if the injections are carried out by an inexperienced person and/or with a lack of anatomical knowledge. The two cases presented here exemplify this problem. In conclusion, both cases demonstrate complications after uncritical injection of hyaluronic acid fillers into "risk" or "expert" regions. While the patients in these two cases recovered completely, the injection of filler substances can also lead to the risk of potentially permanent side effects, such as granuloma, necrosis with scar tissue formation and even blindness. The frequency and severity of complications often show a direct correlation with the qualification or expertise of the person treating and hence injection treatments should be performed solely by physicians.
Collapse
Affiliation(s)
- K Jahn
- Hautklinik des Universitätsklinikums Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland
| | | | | |
Collapse
|
16
|
Marcheggiani Muccioli GM, Wykes P, Hundle B, Grassi A, Roatti G, Funk L. Effects of a synovial fluid substitute on early recovery after arthroscopic subacromial decompression of the shoulder. Musculoskelet Surg 2014; 99:121-6. [PMID: 25346096 DOI: 10.1007/s12306-014-0341-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 10/10/2014] [Indexed: 02/06/2023]
Abstract
PURPOSE The purpose of this pilot study was to determine whether the use of a synovial fluid substitute (Viscoseal) after arthroscopic subacromial decompression (ASD) of the shoulder was safe (primary outcome) and effective in reducing the postsurgical pain on the day of surgery and the time from surgery to discharge (secondary outcomes), compared with patients undergoing standard ASD alone. METHODS Forty-six patients with primary isolated shoulder subacromial impingement were randomly assigned to either undergo SAD alone (control group: n = 21) or to receive 10 ml Viscoseal into the subacromial space at the end of the procedure (treatment group: n = 25). RESULTS No adverse events were reported in either group. All clinical scores improved significantly in each group from preoperative to 12-week follow-up (p < 0.01). The Viscoseal group experienced significantly (p = 0.001) less severe pain 4 h after the surgery {mean 54.0 ± 43.1, median 50 [interquartile range (IQR) 0-100]} and shorter time from surgery to discharge [mean 5.2 ± 1.4, median 5 (IQR 4-6)] than the control group [mean 102.4 ± 40.2, median 100 (IQR 50-150) and mean 11.0 ± 5.3, median 12 (IQR 6-16), respectively]. The Viscoseal group also required less analgesia postoperatively than the control group in the first 8 h: 24% of the Viscoseal required no analgesia, while all patients in the control group required analgesia; 24% of the control group required opiates compared with 4% in the Viscoseal group. CONCLUSION Viscoseal was safe and well tolerated after shoulder arthroscopy. It provided excellent pain relief and a faster discharge time after ASD of the shoulder. The use of Viscoseal should be investigated in larger randomized controlled trials and for other shoulder arthroscopy procedures. LEVEL OF EVIDENCE Level II, Pilot Prospective Comparative Study.
Collapse
Affiliation(s)
- G M Marcheggiani Muccioli
- Laboratorio di Biomeccanica ed Innovazione Tecnologica - Istituto Ortopedico Rizzoli, University of Bologna, via di Barbiano, 1/10, 40100, Bologna, Italy,
| | | | | | | | | | | |
Collapse
|
17
|
Abstract
Viscosupplementation is the intra-articular administration of preparations containing hyaluronic acid or hyaluronate intended to restore the normal biological properties of hyaluronic acid normally found in synovial fluid. Infiltration of hyaluronic acid in the arthritic hip is a more recent technique than viscosupplementation of the knee due to the greater technical difficulty of infiltration to the hip, which requires fluoroscopic or ultrasound guidance. The introduction of high-molecular-weight hyaluronic acid in the treatment permits a single administration and has helped diffuse hip infiltration treatment. A single infiltration reduces patient discomfort caused by the procedure and allows treatment of a larger number of patients. Although the literature has unequivocally proven the possibility of reducing pain in patients affected by hip arthritis following infiltration, the molecular weight and density, the number of infiltrations required for long-term results, and the most appropriate indications for infiltration treatment have yet to be clarified. Selecting the patient is the first obstacle to be overcome. Therefore, infiltration should be considered as an option for patients with initial pain symptoms who have not yet been listed for joint prosthesis surgery. The radiographic criteria require at least a partly preserved joint space, and the clinical criteria of persistent hip pain and full joint mobility seem to be sufficiently effective for selection.
Collapse
|
18
|
Intra-articular hyaluronic acid injection: not for gonarthrosis. Prescrire Int 2013; 22:248-9. [PMID: 24298599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A meta-analysis of 89 randomised trials suggests that, at best, intraarticular hyaluronic acid injection only provides a small relief to patients with osteoarthritis of the knee, but that it can provoke both local reactions and serious adverse effects.
Collapse
|
19
|
|
20
|
Abstract
A 38 Year-old-female presented with diplopia and bilateral lower eyelid swelling 1.5 months after hyaluronic acid filler injection of tear trough deformity. Comprehensive eye examination showed an inferior oblique muscle restriction on the right eye. Diplopia and bilateral lower eyelid puffiness were treated by injection of hyaluronidase which resulted in disappearance of both diplopia and bilateral lower eyelid puffiness.
Collapse
|
21
|
Kamiya K, Nakanishi M, Ishii R, Kobashi H, Igarashi A, Sato N, Shimizu K. Clinical evaluation of the additive effect of diquafosol tetrasodium on sodium hyaluronate monotherapy in patients with dry eye syndrome: a prospective, randomized, multicenter study. Eye (Lond) 2012; 26:1363-1368. [PMID: 22878452 DOI: 10.1038/eye.2012.166eye2012166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
PURPOSE To assess the additive effect of diquafosol tetrasodium on sodium hyaluronate monotherapy in patients with dry eye syndrome. METHODS This study evaluated 64 eyes of 32 patients (age: 62.6±12.8 years (mean±SD)) in whom treatment with 0.1% sodium hyaluronate was insufficiently responsive. The eyes were randomly assigned to one of the two regimens in each patient: topical administration of sodium hyaluronate and diquafosol tetrasodium in one eye, and that of sodium hyaluronate in the other. Before treatment, and 2 and 4 weeks after treatment, we determined tear volume, tear film break-up time (BUT), fluorescein and rose bengal vital staining scores, subjective symptoms, and adverse events. RESULTS We found a significant improvement in BUT (P=0.049, Dunnett test), fluorescein and rose bengal staining scores (P=0.02), and in subjective symptoms (P=0.004 for dry eye sensation, P=0.02 for pain, and P=0.02 for foreign body sensation) 4 weeks after treatment in the diquafosol eyes. On the other hand, we found no significant change in these parameters after treatment in the control eyes. CONCLUSIONS In dry eyes, where sodium hyaluronate monotherapy was insufficient, diquafosol tetrasodium was effective in improving objective and subjective symptoms, suggesting its viability as an option for the additive treatment of such eyes.
Collapse
Affiliation(s)
- K Kamiya
- Department of Ophthalmology, University of Kitasato School of Medicine, Kanagawa 252-0374, Japan.
| | | | | | | | | | | | | |
Collapse
|
22
|
Mazzone L, Gobet R, González R, Zweifel N, Weber DM. Ureteral obstruction following injection of dextranomer/hyaluronic acid copolymer: an infrequent but relevant complication. J Pediatr Urol 2012; 8:514-9. [PMID: 22023846 DOI: 10.1016/j.jpurol.2011.10.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 10/05/2011] [Indexed: 11/17/2022]
Abstract
PURPOSE To report our experience with ureteral obstruction after injection of dextranomer/hyaluronic acid copolymer (Dx/Ha) to treat vesicoureteral reflux, and analyze its possible causes, management and outcome. MATERIALS AND METHODS Retrospective review of patients undergoing injection of Dx/Ha. The charts of patients with clinically relevant ureteral obstruction were evaluated for indications, prior interventions, technique of injection and volume injected. Video recordings obtained during injection were analyzed to detect possible technical errors. RESULTS Fifty-four patients (87 ureters) were treated with Dx/Ha injection in a 5-year period. Five ureters (5.7%) in five patients (9.3%) developed significant ureteral obstruction requiring intervention. Manifestations of obstruction included pain in two patients, urinary tract infections in one and loss of function in one. Increased serum creatinine was observed in a patient with a transplanted kidney. Four obstructions resolved spontaneously (two after percutaneous nephrostomy, two after placement of a ureteral stent) and one required reimplantation. Review of the videos did not reveal any deviation from the usual technique. The volumes injected in the obstructed cases (0.7-1.2 ml) were in the usual range. CONCLUSIONS In this series, the incidence of post Dx/Ha ureteral obstruction was higher than previously reported. Although 4/5 cases resolved spontaneously, they required drainage to relieve symptoms or to improve renal function. Surgeons need to be aware of this complication and include its possible occurrence in the informed consent obtained prior to injection.
Collapse
Affiliation(s)
- Luca Mazzone
- Division of Pediatric Urology, Department of Pediatric Surgery, University Children's Hospital, Zurich, Switzerland
| | | | | | | | | |
Collapse
|
23
|
Dammak A, Taillé C, Marinho E, Crestani B, Crickx B, Descamps V. Granulomatous foreign-body reaction with facial dermal fillers after omalizumab treatment for severe persistent allergic asthma: a case report. Br J Dermatol 2012; 166:1375-6. [PMID: 22233356 DOI: 10.1111/j.1365-2133.2012.10817.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
24
|
Bard H. [Intra-articular injections in osteoarthritis]. Rev Prat 2012; 62:643-650. [PMID: 22730791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Intra-articular injections are part of long-standing symptomatic treatment of osteoarthritis. Numerous products were injected into arthritic joints to whether analgesic, anti-inflammatory or disease-modifying antirheumatic drug. Corticosteroids and viscosupplements are the only permitted as they are validated by controlled studies and part of the treatment of osteoarthritis recommended by scientific societies. The intra-articular injections are effective in limb osteoarthritis, short term for corticosteroids, in the longer term but more delayed, smaller and less constant for viscosupplements, provided they are properly performed. These local treatments do not have to summarize the treatment of osteoarthritis, but integrated into a comprehensive care without neglecting the non-pharmacologic measures. Their benefit should be reassessed regularly for each patient and their effectiveness is often decreased with the progression of osteoarthritis when it does not stabilize. The injection conditions must be rigorous to ensure greater efficiency and reduce the side effects which are rare and usually benign.
Collapse
Affiliation(s)
- Hervé Bard
- Service de chirurgie orthopédique, hôpital européen Georges-Pompidou, 75015 Paris
| |
Collapse
|
25
|
Strand V, Baraf HSB, Lavin PT, Lim S, Hosokawa H. A multicenter, randomized controlled trial comparing a single intra-articular injection of Gel-200, a new cross-linked formulation of hyaluronic acid, to phosphate buffered saline for treatment of osteoarthritis of the knee. Osteoarthritis Cartilage 2012; 20:350-356. [PMID: 22342928 DOI: 10.1016/j.joca.2012.01.013] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Revised: 12/22/2011] [Accepted: 01/19/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the safety and efficacy of a single intra-articular (IA) injection of a new cross-linked hyaluronic acid product, Gel-200, with phosphate buffered saline (PBS, control) in a multi-center randomized controlled trial in patients with symptomatic osteoarthritis (OA) of the knee. DESIGN Patients were randomized 2:1 to receive a single injection of Gel-200 or PBS, after joint aspiration. The primary measure of effectiveness was Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscores by 100-mm Visual Analog Scale (VAS); secondary outcomes included: total WOMAC, physical function, and stiffness subscores; patient and physician global assessments of disease activity, Outcome Measures in Rheumatology Clinical Trials and Osteoarthritis Research Society International (OMERACT-OARSI) strict responders, as well as safety of Gel-200. RESULTS Of 379 patients randomized, safety was evaluated in 377 and efficacy in 375 (98.9% randomized) in the intent-to-treat population. Effectiveness of Gel-200 by WOMAC pain subscores was statistically significant at week 13 (P=0.037). Mean improvements from baseline in WOMAC pain subscores consistently favored Gel-200 at each visit. Effectiveness of Gel-200 treatment was statistically significant over weeks 3-13 by WOMAC total score, physical function, and physician global evaluations (P<0.05). The number of "strict" OMERACT-OARSI responders was statistically significant from weeks 6 to 13 (P=0.022). Adverse events were not significantly different between treatment groups, including serious adverse events considered related to study treatment. CONCLUSIONS This trial demonstrated that a single injection of Gel-200 was well tolerated and relieved pain associated with symptomatic OA of the knee over 13 weeks. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NTC 00449696.
Collapse
Affiliation(s)
- V Strand
- Division of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - H S B Baraf
- The Center for Rheumatology and Bone Research, Wheaton, MD, USA
| | - P T Lavin
- Boston Biostatistics Research Foundation, Framingham, MA, USA
| | - S Lim
- Biostatistics & Data Management Group, Clinical Development Department, Research & Development Division, Seikagaku Corporation, Chiyoda-ku, Tokyo, Japan
| | - H Hosokawa
- Clinical Development Department, Research & Development Division, Seikagaku Corporation, Chiyoda-ku, Tokyo, Japan.
| |
Collapse
|
26
|
Abate M, Schiavone C, Salini V. Hyaluronic acid in ankle osteoarthritis: why evidence of efficacy is still lacking? Clin Exp Rheumatol 2012; 30:277-281. [PMID: 22338615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 10/26/2011] [Indexed: 05/31/2023]
Abstract
Intra-articular injections of hyaluronic acid (HA) are useful in the treatment of osteoarthritis (OA), as shown by studies on knee, hip, and trapezio-metacarpal joints. The positive results can be explained by several factors: the restoration of elastic and viscous properties of intra-articular fluid, the anti-inflammatory and the anti-nociceptive activity, and the normalisation of hyaluronan synthesis and inhibition of hyaluronic acid degradation. However, evidence of efficacy of hyaluronic acid in ankle osteoarthritis is still lacking: several studies have been performed without a control group, or have shown similar results to those obtained with different therapeutic procedures. The aim of this paper is to analyse the reasons which can explain the discrepancy between the sound biological background and the inconclusive clinical results. First, it must be considered that the ankle joint, from a biomechanical point of view, is more complex than other joints, and that greater stress is sustained by the articular surfaces. Second, the limited benefit can be related to the use of hyaluronic acid mostly in cases of post-traumatic osteoarthritis, where the treatment must be addressed to solve the biomechanical problems, and then to restore the rheological properties of the ankle joint. A third important explanation of the failure may be the improper technique of administration, that has been performed in all studies, but one, without imaging guidance. Indeed, it is well known that hyaluronic acid, if not delivered directly into the intra-articular space, is unlikely to be effective.
Collapse
Affiliation(s)
- Michele Abate
- Department of Neuroscience and Imaging, Infrared Imaging Laboratory, Institute of Advanced Biomedical Technologies (ITAB), University G. d' Annunzio Chieti - Pescara, Via dei Vestini 31, 66013, Chieti Scalo (CH), Italy.
| | | | | |
Collapse
|
27
|
Shahrabi Farahani S, Sexton J, Stone JD, Quinn K, Woo SB. Lip nodules caused by hyaluronic acid filler injection: report of three cases. Head Neck Pathol 2012; 6:16-20. [PMID: 21984020 PMCID: PMC3311950 DOI: 10.1007/s12105-011-0304-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Accepted: 09/26/2011] [Indexed: 10/17/2022]
Abstract
Many dermal fillers have been used for reducing facial skin lines and for providing lip augmentation, and hyaluronic acid (HA) is one of the most widely used agents. One of the main commercial forms of HA is Restylane (Q Med, Sweden) produced by microbiological engineering techniques. Although HA is non-immunogenic, hypersensitivity and Granulomatous foreign body reactions have been reported. Herein, we report three female patients (average age 56 years) who presented with firm nodular lesions of the lip and a history of injection with HA (Restylane, Q Med, Sweden). Histopathologically, all cases showed pools of amorphous hematoxyphilic material surrounded by bands of densely collagenized connective tissue with no inflammation or foreign body reaction. Histochemical stains confirmed the presence of acid mucopolysaccharides such as hyaluronic acid. We conclude HA (Restylane, Q Med, Sweden) is an inert filler that may persist at an injection site, resulting in a tumor-like nodule.
Collapse
|
28
|
|
29
|
Abstract
BACKGROUND Volume loss and muscular hyperactivity are two major components of the aging process that contribute to the formation of the folds and wrinkles. Tear trough deformity is one of the most difficult depressions to correct surgically. OBJECTIVE The authors evaluate the results of periorbital filling with hyaluronic acid (HA) in a small series of patients. METHODS Between June 2008 and December 2009, 25 patients were treated with HA to correct tear trough deformities. The HA was administered into the preperiosteal tissues with a serial puncture technique and approximately 0.1 mL was injected at each pass. Each patient's before and after photographs were reviewed by three surgeons; to objectively assess the outcomes, a quantitative scale was used to grade the pre- and postinjection results. The significance of subjective aesthetic evaluation of the photographs was evaluated with the Mann-Whitney U-test. Differences were regarded as significant if probabilities were less than 0.05. RESULTS The mean (SD) volume per side needed to achieve correction was 0.54 (0.27) mL on the right and 0.61 (0.30) mL on the left. Complications included some degree of bruising, erythema, and local swelling. Most patients (88%) had cosmetic improvement according to the independent evaluation. CONCLUSIONS All patients were very satisfied with their results. During the course of the study, the authors determined that the ideal candidates for this treatment are young, with thick skin and a definite hollow.
Collapse
|
30
|
Migliore A, Massafra U, Bizzi E, Vacca F, Martin-Martin S, Granata M, Alimonti A, Tormenta S. Comparative, double-blind, controlled study of intra-articular hyaluronic acid (Hyalubrix) injections versus local anesthetic in osteoarthritis of the hip. Arthritis Res Ther 2009; 11:R183. [PMID: 20003205 PMCID: PMC3003515 DOI: 10.1186/ar2875] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Revised: 09/11/2009] [Accepted: 12/09/2009] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Comparison of intra-articular bacterial-derived hyaluronic acid (Hyalubrix) (HA) with local analgesia (mepivacaine) for osteoarthritis (OA) of the hip. METHODS A pilot prospective, double-blind, 6-month randomized trial of 42 patients with hip OA. HA or mepivacaine was administered twice (once a month) under ultrasound guidance. Efficacy measurements included the Lequesne's algofunctional index, a visual analog scale for pain, concomitant use of analgesia, patient and physician global measurement, and safety. RESULTS Patients in the HA group exhibited a significantly reduced Lequesne's algofunctional index 3 and 6 months after treatment (P < 0.001) and significantly reduced visual analog scale pain scores 3 and 6 months after treatment (P < 0.05) compared with the local anesthetic group. All primary and secondary measures were significantly improved versus baseline, but other than the above were not different from each other at 3 or 6 months. Adverse effects were minimal. CONCLUSIONS This comparative study suggests a beneficial effect and safety of intra-articular HA in the management of hip OA. TRIAL REGISTRATION NUMBER ISRCTN39397064.
Collapse
Affiliation(s)
- Alberto Migliore
- Operative Unit of Rheumatology, San Pietro Fatebenefratelli Hospital, via Cassia 600, 00189 Rome, Italy
| | - Umberto Massafra
- Operative Unit of Rheumatology, San Pietro Fatebenefratelli Hospital, via Cassia 600, 00189 Rome, Italy
| | - Emanuele Bizzi
- Operative Unit of Rheumatology, San Pietro Fatebenefratelli Hospital, via Cassia 600, 00189 Rome, Italy
| | - Francesca Vacca
- Operative Unit of Rheumatology, San Pietro Fatebenefratelli Hospital, via Cassia 600, 00189 Rome, Italy
| | - Severino Martin-Martin
- Department of Internal Medicine, Regina Apostolorum Hospital, via San Francesco 50, 00041 Albano Laziale, Rome, Italy
| | - Mauro Granata
- Operative Unit of Rheumatology, San Filippo Neri Hospital, via Giovanni Martinotti 20, 00135 Rome, Italy
| | - Andrea Alimonti
- Operative Unit of Rheumatology, San Pietro Fatebenefratelli Hospital, via Cassia 600, 00189 Rome, Italy
| | - Sandro Tormenta
- Department of Radiology, San Pietro Fatebenefratelli Hospital, via Cassia 600, 00189 Rome, Italy
| |
Collapse
|
31
|
Abstract
OBJECTIVE Intra-articular hyaluronan (HA) or hylan is approved for the treatment of osteoarthritis (OA) knee pain. The authors review here published evidence of efficacy and safety of intra-articular HA for the treatment of knee pain. Since the systemic safety of nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclo-oxygenase (COX-2) inhibitors for OA knee treatment are a current concern, the authors also offer recommendations for repositioning HA in the OA treatment paradigm. METHODS Relevant HA literature was identified by searching MEDLINE and EMBASE from their inception to April 2008 using the search words hyaluronan, hyaluronic acid, sodium hyaluronate, and hylan G-F 20, with knee and OA. Data from randomized, placebo-controlled trials were reviewed and summarized in this article. While not a systematic review, this article reviews the best available evidence for the use of HA to treat knee OA. RESULTS For the most part, patients in the reviewed studies were adults over the age of 40 with mild to severe symptomatic OA of the knee. Reviewed studies demonstrated significant improvements in pain and physical function with HA or sodium hyaluronate and hylan G-F 20. HA or hylan products were most effective between 5 and 13 weeks after injection with improvements also observed at 14-26 weeks or sometimes longer, and were well tolerated with a low incidence of adverse events. HA also provides beneficial treatment effects when administered in conjunction with other therapies. CONCLUSIONS Intra-articular HA or hylan has proven to be an effective, safe, and tolerable treatment for symptomatic knee OA. In an effort to limit cardiovascular, gastrointestinal, and renal safety concerns with COX-2 selective and nonselective NSAIDs and maximize HA efficacy, the authors proposed using HA earlier in the treatment paradigm for knee OA and also as part of a comprehensive treatment strategy.
Collapse
Affiliation(s)
- Daniel Brzusek
- Northwest Rehabilitation Associates, Bellevue, WA 98004, USA.
| | | |
Collapse
|