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Abstract
Purpose
To evaluate the outcomes of ultrasound-guided hyaluronic acid filler injection in anophthalmic enophthalmos syndrome patients.
Methods
We retrospectively reviewed the clinical records of 14 patients who were diagnosed with anophthalmic enophthalmos syndrome and treated with ultrasound-guided hyaluronic acid filler injection from October 2011 to September 2017. Filler was injected transcutaneous in the retrobulbar area or eyelid under ultrasound guidance and improvement of superior deep sulcus and patient satisfaction after three months of injection were evaluated.
Results
The mean number of injections was 1.2 ± 0.4, and 1.14 ± 0.30 mL of hyaluronic acid filler was used for each injection. There was a significant decrease in mean superior deep sulcus grade from 3.06 ± 0.90 before injection to 0.20 ± 0.56 after injection. Patient satisfaction was higher in the severe superior deep sulcus before injection group who showed greater superior deep sulcus improvement.
Conclusions
Hyaluronic acid filler injections for patients with anophthalmic enophthalmos syndrome were easy to perform in the outpatient department and showed excellent outcomes. The more severe the enophthalmos, the higher the satisfaction after injection, which showed that hyaluronic acid filler injection was an effective treatment for patients with severe enophthalmos syndrome.
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Figure 1.
The grade of superior deep sulcus. (A) Superior deep sulcus is barely perceptible only medial side of left upper eyelid (grade 1). (B) Superior deep sulcus is mild but easily detected only medial side of left upper eyelid (grade 2). (C) Moderate superior deep sulcus is observed in the medial and central of left upper eyelid (grade 3). (D) Severe superior deep sulcus is observed in the medial to lateral of left upper eyelid (grade 4).
Figure 2.
Ultrasound monitoring in case (transverse views, lower eyelid). After filler injection, a hypoechoic filler deposit is observed in retrobulbar space (*) (A, B).
Figure 3.
Preoperative and postoperative photograph of patients. (A) Patient 3 demonstrated anopthalmic enophthalmos, superior deep sulcus grade 3 (OD); (B) same patient one month after received upperlid filler injection (OD). (C) Patient 14 presented mild enophthlmos and significant sulcus deformity (OD). (D) one month after retrobulbar injection, sulcus deformity improved. (E, F) Patient 6 with severe enophthalmos and superior deep sulcus grade 4 (OS) was corrected after retrobulbar injection of 2 syringes of injectable hyaluronic acid. OD = right eye; OS = left eye.
Figure 4.
Spearman correlation scatter plot of sulcus grade and satisfaction. (A) Positive correlation between pre-filler sulcus grade and patient satisfaction r = 0.548, p = 0.034. (B) Positive correlation between deffernces in sulcus grade pre-post filler and patient satisfaction r = 0.560, p= 0.030. p-values were calculated by Spearman correlation test.
Figure 5.
A case of tyndall phenomenon. Patient 2 presents with tyndall phenomenon and upper lid swelling 2 weeks after retrobulbar filler injection on her left eye (A). She received 15 international unit of hyaluronidase. After 1 week of hyaluronidase injection, tyndall phenomenon and upperlid swelling was completely resolved (B).
Table 1.
Baseline characteristics of subjects
Table 2.
Raw data of patients treated with ultrasound guided filler injection in anophthalmic enophthalmos syndrome
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