To investigate clinical and angiographic features of iatrogenic ophthalmic artery and its branches occlusion caused by cosmetic facial filler injections.

Design, Setting, & Participants:

Data of 44 patients of ophthalmic artery and its branches occlusion after cosmetic facial filler injection were obtained retrospectively from a national survey completed by the Korean Retina Society members from 27 retinal centers. Clinical features were compared between patients grouped by angiographic findings and injected filler material.

Main Outcome Measures:

Visual prognosis and its relationship to angiographic findings and injected filler material.


Ophthalmic arterial occlusion was classified into 6 subtypes according to its angiographic findings. Twenty-eight patients had diffuse retinal and choroidal artery occlusions (ophthalmic artery occlusion, generalized posterior ciliary artery occlusion and central retinal artery occlusion). Sixteen patients had localized occlusions (localized posterior ciliary artery occlusion, branch retinal artery occlusion and posterior ischemic optic neuropathy). Patients with diffuse occlusions showed worse initial (2.8 Â)± 0.3 vs. 1.0 ± 1.1, logMAR, p<0.001) and final (2.8 ± 0.5 vs. 0.7 ± 1.0, logMAR, p<0.001) visual acuity and less visual gain (0.0 ± 0.3 vs. 0.3 ± 0.6, logMAR, p=0.050) compared to those with localized occlusions. Autologous fat injection patients (n=22) were associated with diffuse arterial occlusions (86.4% vs. 38.5%, p=0.007), worse visual prognosis (final visual acuity, 2.6 ± 0.8 vs. 1.4 ± 1.4, logMAR, p=0.011; visual gain, -0.1 ± 0.2 vs. 0.3 ± 0.6, logMAR, p=0.022) and higher incidence of combined brain infarction (45.5% vs. 7.7%, p=0.027) compared to hyaluronic acid injection patients (n=13).

Conclusions & Relevance:

Clinical features of iatrogenic occlusion of the ophthalmic artery and its branches following cosmetic filler injection were diverse according to the location and extent of obstruction, and the injected filler material. Interestingly, autologous fat injection was associated with a worse visual prognosis and a higher incidence of combined cerebral infarction. Therefore, extreme caution and care should be taken during these injections and clinician should be aware of diverse spectrum of complication following the cosmetic filler injections.

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