f1-co-2-679: 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).

Mentions: A 27-year-old female came into our clinic through the emergency department with a sudden visual loss of her right eye after receiving an autologous fat injection into the right nasolabial fold on the same day. She had received the cosmetic surgery at a local plastic surgery clinic and about ten minutes after the injection, she complained of a sudden blackout of her right eye. There was nothing particular with her past history, family history, and other physical examinations. Slight ptosis of her right eyelid was noticeable and petechia around the right nasolabial fold was seen due to the fat injection (Figure 1). Corrected visual acuity of her right and left eye was hand motion and 1.0 and the intraocular pressure was measured 8 mmHg and 16 mmHg with noncontact tonometer. On slit lamp examinations, the cornea was clear and the anterior chamber was deep with no cells visible. The right pupil was fixed and mid-dilated. Fundus examination of the right eye showed multiple whitish patchy lesions with macular edema (Figure 2). Fluorescein angiogram showed deterioration of choroidal circulation with patchy choroidal filling. Arm-to-retina circulation time and retinal arteriovenous passage time were delayed to 30 seconds and 20 seconds, respectively (Figure 3). No specific findings were seen in echocardiography, carotid Doppler ultrasonography, brain computed tomography, and serological examinations.

Park SH, Sun HJ, Choi KS - Clin Ophthalmol (2008)

Bottom Line: There was no response in flash visual evoked potential (VEP).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.

Affiliation: Department of ophthalmology, Soonchunhyang University College of Medicine, Seoul, Korea.

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.