Clinical Characteristics and Factors Related to Visual Prognosis of Ophthalmic Artery and its Branch Occlusion Caused by Cosmetic Facial Filler Injection
Objective To evaluate the clinical characteristics and factors related to visual prognosis of ophthalmic artery and its branch occlusion caused by cosmetic facial filler injection.Methods In this retrospective case study,a total of 26 patients with ophthalmic symptoms including visual loss,diplopia,or ptosis immediately after cosmetic facial filler injection were included.Clinical and imaging data of all patients were collected and analyzed.Results Among 26 patients,hyaluronic acid,autologous fat,and stem cell preparation was injected in 23,2,and 1 case,respectively.Injection point was located in the forehead,forehead combined with glabella,glabella,glabella combined with nasal root,nasal root,nasal ala,eyelid,and temporal scalp in 8,4,3,1,4,1,4,and 1 case,respectively.Clinical manifestations included ophthalmic artery occlusion(2 cases),central retinal artery occlusion(CRAO)(7 cases,including one case of incomplete CRAO),posterior ciliary short artery occlusion[12 cases,including 6 cases of non-arteritic anterior ischemic optic neuropathy(NAION),3 cases of non-arteritic posterior ischemic optic neuropathy,and 3 cases of focal choroidal ischemia],external ophthalmoplegia(5 cases,including 4 cases of ophthalmic artery muscular branch occlusion,and one case of oculomotor nerve palsy),ptosis(4 cases),and mydriasis(2 cases).Among them,6 patients had two ocular involvement manifestations at the same time,including CRAO+focal choroidal ischemia in 2 cases,NAION+focal choroidal ischemia in 1 case,NAION+muscular branch occlusion in 1 case,NAION+oculomotor nerve palsy in 1 case,ptosis+muscular branch occlusion in 1 case.Cranial MRI examination revealed new focal cerebral infarctions in 3 cases.Among 18 patients with retinal or optic nerve involvement,11 cases showed complete CRAO or diffuse ischemic optic neuropathy,and no visual improvement after treatment;7 patients showed incomplete CRAO or segmental ischemic optic neuropathy,and evident visual improvement after treatment.Conclusions Visual prognosis of ophthalmic artery and its branch occlusion caused by cosmetic facial filler injection is poor.Incomplete CRAO,segmental ischemic optic neuropathy,and best corrected visual acuity ≥0.02 at baseline are main factors indicating a relatively good visual prognosis.