Anterior Ischemic Optic Neuropathy Following Periocular Autologous Fat Injection

Myun Ku; Hae Jung Paik; Dong Heun Nam; Dae Yeong Lee

doi:10.3341/jkos.2010.51.8.1155

Journal List > J Korean Ophthalmol Soc > v.51(8) > 1008629

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Ku, Paik, Nam, and Lee: Anterior Ischemic Optic Neuropathy Following Periocular Autologous Fat Injection

Original Article

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

Published online: 7 September 2010

DOI: https://doi.org/10.3341/jkos.2010.51.8.1155

Anterior Ischemic Optic Neuropathy Following Periocular Autologous Fat Injection

Myun Ku, MD, Hae Jung Paik, MD, PhD, Dong Heun Nam, MD, PhD, Dae Yeong Lee, MD

Department of Ophthalmology, Gachon University Gil Hospital, Incheon, Korea

Address reprint requests to Dae Yeong Lee, MD Department of Ophthalmology, Gachon University Gil Hospital # 1198 Kuwol-dong, Namdong-gu, Incheon 405-760, Korea Tel: 82-32-460-3364, Fax: 82-32-460-3358, E-mail: ldy90@hanmail.net

Received 2 July 2009 Accepted 29 June 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Autologous fat injection, Ciliary artery occlusion, Ischemic optic neuropathy

References

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Figure 1.

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

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.

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).

Figure 4.

Initial fundus photograph shows disc edema in her left eye.

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).

Figure 6.

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

Figure 7.

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

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.

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