Consensus Opinion on Safe Injection Technique and Management of PDLLA-HA200-Induced Visual Impairment

J Craniofac Surg. 2026 May 1;37(5):1103-1109. doi: 10.1097/SCS.0000000000012271. Epub 2025 Dec 8.

Abstract

Poly- D , L -lactic acid with hyaluronic acid (PDLLA-HA) represents a next-generation injectable combining the collagen-stimulating property of poly- D , L -lactic acid (PDLLA) microspheres with non-cross-linked hyaluronic acid (HA) as a carrier. One rare but devastating complication is visual field impairment and blindness due to inadvertent intravascular injection. Recognizing the need for a dedicated consensus on the management of PDLLA-HA-induced visual impairment, a panel of experts comprising oculoplastic surgeons, dermatologists, and aesthetic physicians was convened to give a consensus on safe practice with PDLLA-HA 200 (Juvelook Volume/Lenisna) and develop a management algorithm for the management of PDLLA-HA-induced blindness.

Keywords: Dermal fillers; hyaluronic acid; injections; polylactic acid-polyglycolic acid copolymer; subcutaneous; vision disorders.

Publication types

  • Consensus Statement
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Blindness* / chemically induced
  • Blindness* / therapy
  • Dermal Fillers* / administration & dosage
  • Dermal Fillers* / adverse effects
  • Humans
  • Hyaluronic Acid* / administration & dosage
  • Hyaluronic Acid* / adverse effects
  • Injections / adverse effects
  • Injections / methods
  • Microspheres
  • Polyesters* / administration & dosage
  • Polyesters* / adverse effects
  • Vision Disorders* / chemically induced
  • Vision Disorders* / therapy

Substances

  • Hyaluronic Acid
  • poly(lactide)
  • Dermal Fillers
  • Polyesters