Abstract Background and aims Tissue-filler related visual loss (TFRVL) due to retinal arterial occlusions represents an uncommon but serious complication of these procedures. We aimed to identify the effectiveness of hyaluronidase and thrombolysis for TFRVL through systematic review and descriptive analysis. Methods A systematic search on PubMed and Scopus identified reports of TFRVL. The protocol was registered with PROSPERO (CRD42022355129). Studies reporting visual acuity (VA) after TFRVL (baseline VA) and VA after treatments were included, with individual patient data (IPD) extracted when available. Visual improvement was defined as a ≥0.3 LogMAR VA reduction. Visual outcomes were compared between patients treated with hyaluronidase or thrombolysis and those who were not, including other therapies and no treatment. Results From 290 manuscripts screened, IPD from 42 studies were included, resulting in 91 patients (93 affected eyes). Mean age was 34.9 years, 96.7% were female. Hyaluronic acid was the most used filler (64%) 93.5% of patients received some treatment; hyaluronidase was administered in 64.1% of cases and intravenous thrombolysis in 19.6%. Baseline and follow-up VA data were available for 76 affected eyes, with significant visual improvement in 36%. Visual improvement rates did not differ significantly between those treated with hyaluronidase and those who were not (63% vs. 37%), nor between those treated with thrombolytics and those who were not (15% vs. 85%). Conclusions No significant differences were observed in hyaluronidase or fibrinolysis use between patients with visual improvement and those with stable or worsening outcomes. IPD for the remaining identified studies have been requested to corresponding authors for further IPD meta-analysis. Conflict of interest Anna Vargas, Aina Sánchez-Quin, Adrián Valls, Marta Balboa, Cristina Del Valle, Carles Vázquez, Bárbara Yugueros, Mònica Millán, Susana Ruiz-Bilbao, Alejandro Bustamante: nothing to disclose Figure 1 - belongs to Methods Figure 2 - belongs to Results
Vargas-Verdaguer et al. (2026) studied this question.