Optic nerve ischemia secondary to cosmetic procedures with botulinum toxin and platelet-rich plasma injection: report of two cases

Laura C. Rodríguez-Fonseca, Servicio de Radiología, Universidad del Valle, Cali, Colombia
Jorge E. Izquierdo-Ordóñez, Servicio de Radiología, Universidad del Valle, Cali, Colombia
Daniel M. Varón-Orjuela, Servicio de Neurorradiología, Clínica Imbanaco, Cali, Colombia
Carlos A. Castro-Galvis, Servicio de Medicina de Urgencias, Pontificia Universidad Javeriana, Cali, Colombia
Juan S. Serna-Trejos, Servicio de Infectología, Clínica Colsanitas S.A., Clínica Sebastián de Belalcázar, Cali, Colombia

Facial aesthetic injections have steadily increased; although most are safe, there are rare but devastating complications, as blindness and strokes due to retrograde embolization into the ophthalmic artery. Early clinical-radiological recognition and diffusion-focused imaging protocols are essential. Two cases are described. Case 1: 48-year-old woman with loss of left temporal hemifield after botulinum toxin and calcium hydroxyapatite injection. Angiography: nasal choroidal hypoperfusion consistent with ciliary branch occlusion. Magnetic resonance imaging (MRI): restriction on Diffusion-Weighted Imaging (DWI) and decreased Apparent Diffusion Coefficient (ADC) of the posterior intraorbital segment with no FLAIR representation, consistent with hyperacute ischemia. She received methylprednisolone and follow-up. Case 2: 59-year-old woman with left amaurosis and facial paralysis after platelet-rich plasma injection. Examination: pale papilla and whitish retina. MRI: ischemia of the left optic nerve with muscle edema and two parietal/occipital cortical infarcts. Angiography: occlusion of the ophthalmic artery; NIHSS 0. Both cases support the embolic mechanism, underscoring the diagnostic value of DWI/ADC, the activation of urgent stroke protocols, and prevention based on anatomy, technique, and equipment.

Keywords: Optic neuropathy ischemic. Retinal artery occlusion. Dermal fillers. Platelet-rich plasma. Adverse effects.