In Search for Beauty, Some Find Vision Loss

Neil Osterweil

September 18, 2014

LONDON — Some patients who get facial injections to look good may end up seeing very poorly as a result of retrograde occlusion of ocular arteries, warn researchers.

"The risk of complications is higher when injections are made to the area supplied by the dorsal nasal and supratrochlear arteries, and when the injections are performed by inexperienced or noncertified personnel," said Tharikarn Sujirakul, MD, a research fellow in ophthalmology at Columbia University College of Physicians and Surgeons in New York City.

Reporting here at the 14th EURETINA Congress, Dr. Sujirakul described six patients who received dermal filler injections in their faces with either hydrophilic gel, collagen, silicone, or an unknown material and developed retrograde arterial occlusions, causing either temporary or permanent vision loss in one eye.

Dermal filler injections are common procedures that are increasing in popularity in aesthetic practice because they are minimally invasive, can be performed simply and quickly, and generally have predictable outcomes ― at least for dermatologic purposes, Dr. Sujirakul pointed out.

Her team reported results from a small observational series of patients who presented with acute vision loss to one of two university-based hospitals in New York City.

Beauty in the Eye of the Beholder

Four of the patients had injections at the nasal bridge, one in the forehead, and one in the temporal fossa. Three of the patients ― a 31-year old man, a 20-year-old woman, and a 26-year-old woman ― presented with symptoms that included lid swelling, ptosis, proptosis, and in two cases, relative afferent pupillary defects.

These patients were found to have occlusion of the posterior ciliary artery with anterior ischemic optic neuropathy. All three had had injections in the nasal bridge. Visual acuities ranged from 20/25 to 20/200.

A fourth patient, a 20-year-old man, presented with afferent pupillary defects, and had multiple branch retinal artery occlusions, with a visual acuity of 20/200. The remaining two patients had occlusion of the ophthalmic artery, and one also had occlusion of the middle cerebral artery. Each of these patients had no light perception in the affected eye.

These are really terrible side effects. Dr. Tersio Avitabile

At follow-up, of the three patients with posterior ciliary artery occlusion, two (20/30 and 20/200 at presentation) had recovery to 20/20, but for one patient, vision deteriorated from 20/25 to 20/40.

The patient with multiple branch retinal artery occlusions had partial visual improvement, from 20/200 at presentation to 20/60 at follow-up, but the two patients with ophthalmic artery occlusions had apparently permanent visual loss in their affected eyes.

The findings indicate that visual prognosis depends on the affected artery, Dr. Sujirakul said.

"These are really terrible side effects," commented Tersio Avitabile, MD, professor of ophthahlmology at the University of Catania, Italy. Dr. Avitabile was comoderator of the session in which the data were presented, but he was not involved in the study.

In an interview with Medscape Medical News, Dr. Avitabile said that because the patients presented spontaneously, the actual incidence of ocular arterial occlusion is not known. Nonetheless, because the occlusions occurred following an elective, medically unnecessary procedure, such potentially devastating visual consequences are unacceptable.

Dr. Sujirakul and Dr. Avitabile have reported no relevant financial relationships.

14th EURETINA Congress. Abstract presented September 12, 2014.


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