Nonhuman Primate Model of Super-selective Intra-arterial Ophthalmic Arterial Interventional Thrombolysis for Treatment of Ophthalmic Arterial Embolism Resulting From Hyaluronic Acid Filler Cosmetic Injection.

Summary

A rhesus monkey model of ophthalmic artery embolism from HA filler was established and reperfused via super-selective intra-arterial hyaluronidase thrombolysis. Recanalization at 1, 4, or even 24 hours improved visual function but residual dysfunction and retinal injury persisted; single-cell RNA-seq showed decreased rhodopsin expression with longer ischemia.

Key Findings

• Established a rhesus monkey model of ophthalmic artery embolization by intra-arterial HA injection and achieved reperfusion via intra-arterial hyaluronidase.
• Recanalization at 1, 4, and 24 hours improved visual function, though some dysfunction persisted on electroretinography.
• Histology confirmed retinal cellular damage post-embolization; scRNA-seq revealed decreased rhodopsin expression with longer ischemia time.

Clinical Implications

Supports considering super-selective intra-arterial hyaluronidase thrombolysis within up to 24 hours after HA filler-related ophthalmic artery embolism, while counseling patients about residual deficits.

Limitations

• Preclinical animal study with unspecified sample size; no randomized comparator or dose-finding.
• Residual functional impairment despite reperfusion; long-term outcomes not assessed.

Future Directions

Prospective clinical registries and controlled trials to define optimal dosing, timing, and adjuncts for intra-arterial hyaluronidase; validation of molecular markers as prognostic indicators.