J Korean Ophthalmol Soc.  2010 Aug;51(8):1155-1160.

Anterior Ischemic Optic Neuropathy Following Periocular Autologous Fat Injection

• Ku M
• Paik HJ
• Nam DH
• Lee DY

Abstract

PURPOSE
To report an unusual case of anterior ischemic optic neuropathy and choroidal ischemia after injection of autologous fat into the periorbital region due to embolism of the short posterior ciliary artery without involving the retinal artery.
CASE SUMMARY
A 39-year-old female presented with sudden blurred vision, diplopia and ptosis of her left eye immediately after receiving an autologous fat injection into the periorbital area. The first ophthalmologic examination revealed that the patient s left eye had decreased visual acuity, relative afferent pupillary defect, exotropia, and hypertropia. Fundus examination of the left eye showed disc edema. Fluorescein angiography showed multiple choroidal vascular filling defects at the early phase and wedge-shaped or geographic fluorescein staining at the superior, inferior, and temporal peripheral areas at late phase. Humphrey visual field test results disclosed an inferior visual field defect. On the follow-up visit after oral steroid therapy (prednisolone 30 mg) for 7 days, diplopia disappeared and visual acuity recovered to 1.0. The inferior visual field defect and relative afferent pupillary defect were still present.

Keyword

Autologous fat injection; Ciliary artery occlusion; Ischemic optic neuropathy

MeSH Terms

Adult
Choroid
Ciliary Arteries
Diplopia
Edema
Embolism
Exotropia
Eye
Female
Fluorescein
Fluorescein Angiography
Follow-Up Studies
Humans
Ischemia
Optic Neuropathy, Ischemic
Pupil Disorders
Retinal Artery
Strabismus
Vision, Ocular
Visual Acuity
Visual Field Tests
Visual Fields
Fluorescein

Figure

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  Figure 1. Initial photograph of the patient shows mild ptosis, exotropia and hypertropia of her left eye.

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  Figure 2. (A) Composite photograph of nine-cardinal gaze at the first visit reveals left exotropia, hypertropia and significant limitation in adduction. (B) Hess screen test at the first visit reveals medial rectus muscle and inferior rectus muscle underaction of her left eye.

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  Figure 3. (A) Humphrey 24–2 visual field at the first visit showing inferior visual field defect. (B) Pattern visual evoked potential (VEP) at the first visit showing delayed p100 latency (137 ms).

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  Figure 4. Initial fundus photograph shows disc edema in her left eye.

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  Figure 5. Initial fluorescein angiogram of the left eye shows multiple choroidal vascular filling defects and delayed filling of the optic disc at the early phase (A) and wedge- shaped or geographic fluorescein staining at the superior, inferior and temporal peripheral area at the late phase (B, C and D).

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  Figure 6. Humphrey visual field at 7 days after the accident showing remained inferior visual field defect.

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  Figure 7. Three months after the accident, delayed p100 latency (132 ms) were still seen on visual evoked potential (VEP) of the left eye.

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  Figure 8. Fundus photograph 3 months after the initial visit. (A) Disc swelling is subsided. (B-D) Initial lesions at the superior, inferior and temporal area ultimately has been changed into chorioretinal pigmentary degenerative lesions.

Reference

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