Facial Filler Injections Can Lead to Ophthalmic Artery Occlusions

By Rob Goodier

April 10, 2014

NEW YORK (Reuters Health) - Off-label injection of wrinkle fillers into the forehead can lead to a half dozen types of ophthalmic artery occlusion, a new paper warns.

The consequences can be grave, depending on the location and size of the occlusion and on the filler used, with the worst outcomes linked to autologous-fat injections, according to the research.

"Physician and patients should know this procedure causes devastating complications, even if the incidence is rare, including permanent blindness, facial skin necrosis, and even brain stroke. Thorough explanation and great caution are needed before and during the procedures," Dr. Kyu Hyung Park from Seoul National University College of Medicine, who led the research, told Reuters Health by email.

The findings were published online March 27 in JAMA Ophthalmology.

The Korean team examined records from 44 patients who suffered occlusion of the ophthalmic artery after filler injections. They characterized the occlusions as either diffuse or localized. Diffuse occlusions included decreases in retinal or choroidal perfusion and affected the entire retina or choroid, and they had poor visual outcomes. Localized occlusions affected only focal vascular regions in the retina or choroid.

The researchers further subdivided the two categories of occlusions into three types each.

Diffuse occlusions included ophthalmic artery occlusion with retinal and choroidal insufficiency (17 patients), generalized posterior ciliary artery occlusion (three patients) and central retinal artery occlusion (eight patients). Localized occlusions included localized posterior ciliary artery occlusion (four patients), branch retinal artery occlusion (10 patients) and posterior ischemic optic neuropathy (two patients).

The occlusions appeared linked to the kind of filler used. Patients who received autologous-fat injections were the most likely to have diffuse occlusions and brain lesions, the team reports.

As many as 86% of those in the study who received autologous fat suffered diffuse occlusions, compared to 39% of those who received hyaluronic acid (p=0.007). And brain scans revealed lesions in 46% of autologous-fat recipients compared to 8% of hyaluronic-acid recipients (p=0.03).

"When using autologous fat as a cosmetic filler, physicians should be extremely cautious and monitor patients," Dr. Park said.

Neither the number nor the site of the injections seemed to affect the type of occlusion or visual outcomes, however.

The difference in outcomes between autologous fat and hyaluronic acid was one of the paper's interesting findings, Dr. Richard Roe from Retina-Vitreous Associates Medical Group in Los Angeles, who was not involved in this study, told Reuters Health by email.

Although it is rare, evidence for this risk has been mounting. Dr. Roe published a case series in the same journal last month, showing permanent blindness and vision impairment in patients who had forehead injections with three different types of fillers (see Reuters Health article of March 14, 2014).

"Given the dramatic rise in cosmetic facial filler injections over the past decade it is not surprising that we are seeing more reports of complications," Dr. Roe says. "These results only reinforce the fact that these cosmetic procedures are not without risk and that blindness, though likely a very small risk, should still be discussed as a possibility during the informed consent process."

SOURCE: http://bit.ly/R2nTHw

JAMA Ophthalmol 2014.

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