Ophthalmic Artery Occlusion After Cosmetic Facial Filler Injections

KH Park, YK Kim, SJ Woo, SW Kang, WK Lee, KS Choi, HW Kwak, IH Yoon, K Huh, JW Kim.

Facial fillersABSTRACT

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 MEASURES
Visual 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.

KH Park, YK Kim, SJ Woo, SW Kang, WK Lee, KS Choi, HW Kwak, IH Yoon, K Huh, JW Kim.
Iatrogenic Occlusion of the Ophthalmic Artery After Cosmetic Facial Filler Injections: A National Survey by the Korean Retina Society. JAMA Ophthalmol 2014 Mar 27;[EPub Ahead of Print]