Multifocal Retinal and Ciliary Artery Occlusion with Submacular Hemorrhage Following Cosmetic Facial Filler Injection

Abstract

Purpose: Retinal artery occlusion and ciliary artery occlusion (CAO) may occur as complications after cosmetic filler injections. However, submacular and subhyaloid hemorrhage have not been reported after cosmetic filler injection. Herein, we report the first case of subretinal hemorrhage after iatrogenic multifocal retinal and CAO following facial filler injection. Case summary: A 44-year-old woman with no relevant medical history presented with a sudden upper visual field defect of the right eye immediately after receiving hyaluronic acid cosmetic facial filler injection in the glabellar region. The patient was diagnosed with multiple branch retinal and posterior CAO of the right eye. On the fourth day of follow-up, submacular and subhyaloid hemorrhage was observed. Intravitreal injection of 1.25 mg bevacizumab and 0.2 mL pure C3F8 (octafluoropropane) gas was performed. At the 2-month follow-up, subretinal and subhyaloid hemorrhage at the macula had resolved. Without further treatment, the retina was stable with no further recurrence through the 1-year follow-up. Conclusions: Submacular and subhyaloid hemorrhage following branch retinal and posterior CAO immediately after cosmetic facial filler injection is a rare, but serious complication. Although the pathogenic mechanism for subretinal hemorrhage remains unclear, bevacizumab injection combined with 0.2 mL pure C3F8 gas injection may be a possible treatment option when faced with such complications.