Korean J Ophthalmol.  2011 Oct;25(5):358-361. 10.3341/kjo.2011.25.5.358.

Ophthalmic Artery Obstruction and Cerebral Infarction Following Periocular Injection of Autologous Fat

• Lee CM
• Hong IH
• Park SP

• KMID: 1098642
• DOI: http://doi.org/10.3341/kjo.2011.25.5.358

Abstract

We report a case of ophthalmic artery obstruction combined with brain infarction following periocular autologous fat injection. The patient, a 44-year-old woman, visited our hospital for decreased visual acuity in her left eye and dysarthria one hour after receiving an autologous fat injection in the periocular area. Her best corrected visual acuity for the concerned eye was no light perception. Also, a relative afferent pupillary defect was detected in this eye. The left fundus exhibited widespread retinal whitening with visible emboli in several retinal arterioles. Diffusion-weighted magnetic resonance imaging of the brain showed a hyperintense lesion at the left insular cortex. Therefore, we diagnosed ophthalmic artery obstruction and left middle cerebral artery infarction due to fat emboli. The patient was managed with immediate ocular massage, carbon dioxide, and oxygen therapy. Following treatment, dysarthria improved considerably but there was no improvement in visual acuity.

Keyword

Abdominal fat; Cerebral infarction; Ophthalmic artery; Retinal artery occlusion

MeSH Terms

Adult
Arterial Occlusive Diseases/diagnosis/*etiology
Female
Fluorescein Angiography
Follow-Up Studies
Fundus Oculi
Humans
Infarction, Middle Cerebral Artery/*complications/diagnosis
Magnetic Resonance Imaging
*Ophthalmic Artery
Orbit
Subcutaneous Fat/*transplantation
Transplantation, Autologous/adverse effects
Visual Acuity

Figure

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  Fig. 1 After an autologous fat injection in the left periocular area, the skin color of the patient's nose changed to purple.

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  Fig. 2 (A) The fundus photo of the right eye shows no abnormal findings. (B) At 3 hours after the autologous fat injection, a photo of the fundus of the left eye shows a cherry red spot with visible emboli in several retinal arteries. (C) At 24 hours after the injection, a photo of the fundus of the left eye shows marked retinal edema, disc swelling and multiple fat emboli. (D) At 2 months after the injection, a photo of the fundus of the left eye shows optic disc atrophy, multiple retinal hemorrhages and a fibrous change on its posterior pole.

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  Fig. 3 (A) Fluorescein angiography revealed no abnormalities in the right eye, (B) but in the left eye it showed markedly prolonged choroidal filling around the optic disc and delays in both retinal arterial filling and retinal arteriovenous transit time.

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  Fig. 4 (A) The diffusion weighted brain magnetic resonance imaging showed an ill-defined hyperintense lesion at the left insular cortex and (B) decreased signal intensity at the same lesion on the afferent diffusion coefficient map. These results indicate recent brain infarction.

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