Images in Clinical Medicine
Blindness after Fat Injections
N Engl J Med 2011; 365:2220December 8, 2011
- Article
A 32-year-old man presented with vision loss in the left eye. one week earlier, while under local anesthesia, he had had an autologous fat injection into his forehead for correction of glabellar frown lines. The patient reported that while he was receiving the injection, he felt a sudden, severe periocular pain and had complete vision loss in his left eye. On physical examination, the patient's level of consciousness was normal, without aphasia. Neurologic examination was normal except that he had no light perception in the left eye. The left pupil was dilated. In the left eye, no direct pupillary light reflex was observed and the indirect pupillary light reflex was slow. Retinal examination of the affected eye showed an edematous optic disk and widespread retinal whitening, with interruption of several arterioles (Panel A). Follow-up photography and fluorescein angiography confirmed multiple retinal hemorrhages, occlusions of several retinal arterioles with visible fat emboli (Panel B, arrows), and complete lack of perfusion of the tissue bed in hypofluorescent areas (Panel C). No abnormality was seen on magnetic resonance angiography of the brain. At the 2-month follow-up visit, the patient's vision had not improved.
Young-Hoon Park, M.D.
Kyu Seop Kim, M.D.
Seoul St. Mary's Hospital, Seoul, South Korea
parkyh@catholic.ac. kr
