Iatrogenic Occlusion of the Ophthalmic Artery After Cosmetic Facial Filler Injections

Abstract

for the Korean Retina Society IMPORTANCE Iatrogenic occlusion of the ophthalmic artery and its branches is a rare but devastating complication of cosmetic facial filler injections.OBJECTIVE To investigate clinical and angiographic features of iatrogenic occlusion of the ophthalmic artery and its branches caused by cosmetic facial filler injections. DESIGN, SETTING, AND PARTICIPANTS Data from 44 patients with occlusion of the ophthalmic artery and its branches after cosmetic facial filler injections were obtained retrospectively from a national survey completed by members of the Korean Retina Society from 27 retinal centers. Clinical features were compared between patients grouped by angiographic findings and injected filler material. MAIN OUTCOMES AND MEASURESVisual prognosis and its relationship to angiographic findings and injected filler material.RESULTS Ophthalmic artery occlusion was classified into 6 types according to angiographic findings. Twenty-eight patients had diffuse retinal and choroidal artery occlusions (ophthalmic artery occlusion, generalized posterior ciliary artery occlusion, and central retinal artery occlusion). Sixteen patients had localized occlusions (localized posterior ciliary artery occlusion, branch retinal artery occlusion, and posterior ischemic optic neuropathy). Patients with diffuse occlusions showed worse initial and final visual acuity and less visual gain compared with those having localized occlusions. Patients receiving autologous fat injections (n = 22) had diffuse ophthalmic artery occlusions, worse visual prognosis, and a higher incidence of combined brain infarction compared with patients having hyaluronic acid injections (n = 13).CONCLUSIONS AND RELEVANCE Clinical features of iatrogenic occlusion of the ophthalmic artery and its branches following cosmetic facial filler injections were diverse according to the location and extent of obstruction and the injected filler material. Autologous fat injections were associated with a worse visual prognosis and a higher incidence of combined cerebral infarction. Extreme caution and care should be taken during these injections, and physicians should be aware of a diverse spectrum of complications following cosmetic facial filler injections.

Ophthalmoplegia as a complication of cosmetic facial filler injection

“…This indicates an unfavourable prognosis of ophthalmoplegia from a facial filler injection. Whereas previous studies reported a worse visual prognosis and more frequent cerebral infarctions with the use of autologous fat as a filler material than with hyaluronic acid (Park et al 2014), further progression of the emboli beyond the ophthalmic artery and resultant cerebral infarctions did not occur in our patients with hyaluronic acid injection. However, all the patients including the one who had intra-arterial thrombolysis using hyaluronidase remained without light perception in the involved eye during the follow-up of more than 8 months.…”

“…Our patients showed a relative sparing of the lateral rectus muscle, while previous studies reported total ophthalmoplegia after filler injections (Kim & Choi 2013;Park et al 2014). Occlusion of the medial/inferior muscular trunk arising from the ophthalmic artery paralyses the medial and inferior recti and inferior oblique muscles, while obstruction of the lateral/superior trunk causes palsies of the levator palpebrae, superior rectus and superior oblique muscles.…”

“…YI: None; SKS: Bausch and Lomb (C), Allergan (R), Bioptigen (P), Zeiss (C), Synergetics (P); JPE: Bioptigen (C, P), Thrombogenics (C, R), Synergetics (P), Genentech (R), Leica (C), Zeiss (C), Alcon (C). nterest in rejuvenation has increased the number of aesthetic soft tissue augmentation of the face using the filler injections (Park et al 2014). However, complications of filler injection include blindness, ophthalmoplegia or strokes (Coleman 2002;Peter & Mennel 2006;Park et al 2012).…”

Prevention and management of vision loss relating to facial filler injections

“…Most cases in Asia are documented in South Korea, where filler injections are common. (3) However, case reports have also emerged from China. While injections into other facial sites (e.g.…”

“…2). (3,4,11,12) Understanding the specific anatomical planes at the area of injection is also important. For the nose, the supraperiosteal or supraperichondrial planes are relatively bloodless.…”