Sudden unilateral visual loss after autologous fat injection into the nasolabial fold

Abstract

A 27-year-old female presented with sudden visual loss of her right eye after receiving an autologous fat injection into the right nasolabial fold. Fundus examination of the right eye showed multiple whitish patchy lesions with macular edema. Fluorescein angiogram showed deterioration of choroidal circulation with patchy choroidal filling and arm-to-retina circulation time and retinal arteriovenous passage time were delayed to 30 seconds and 20 seconds, respectively. There was no response in flash visual evoked potential (VEP). High dose steroid therapy (methylprednisolone 1 g/day/i.v.) was done and about 2 weeks later, the disc edema subsided and retinal arteriovenous passage time of fluorescein angiogram was normalized but there was no improvement in visual acuity. Absence of a cherry red spot, deterioration of choroidal circulation with patchy choroidal fillings seen in fluorescein angiogram, and no response in flash VEP suggests multiple choroidal infarction due to perfusion defect of the short posterior ciliary artery. The autologous fat injected is thought to have entered the dorsal nasal artery and the retrograde migration of the emboli to the ophthalmic artery might have caused the multiple occlusions of the short posterior ciliary artery.

Keywords: autologous fat injection; ciliary artery occlusion; ischemic optic neuropathy.

Figure 1

Initial photograph of the patient shows mild ptosis of her right eye (right), petechia of autologous fat injection site along the right nasolabial fold (left).

Figure 2

Initial fundus photograph of the patient’s right eye shows multiple whitish patchy lesions and macular edema.

Figure 3

Initial fluorescein angiogram of the patient shows delayed choroidal filling (right) at early phase and multiple patchy choroidal filling (left) at late phase.

Figure 4

5 days after the accident, disc edema has increased with more apparent multiple whitish patchy lesions (left), the flash visual evoked potential (VEP) of the right eye shows no response (right).