Ophthalmic artery occlusion secondary to fat emboli after cosmetic nasal injection of autologous fat.
Ophthalmic artery occlusion secondary to fat emboli after cosmetic nasal injection of autologous fat.
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DOI：
10.1097/iae.0b013e31826a6897
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发表时间：
2012-11
期刊：
影响因子：
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通讯作者：
L. Xing;David Almeida;Michel J. Belliveau;H. Hollands;R. Devenyi;Alan K. Berger;J. Gale
中科院分区：
文献类型：
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作者：
L. Xing;David Almeida;Michel J. Belliveau;H. Hollands;R. Devenyi;Alan K. Berger;J. Gale
一名 23 岁的女性在鼻子左侧接受了自体未纯化脂肪注射，以增强美观的软组织。 90 分钟内，她的左眼失去了光感。左侧相对传入瞳孔存在 V 级缺损。左侧眼底检查，视网膜广泛泛白，有樱桃红色斑点，小动脉盒状凹陷，视网膜小动脉内有多发脂肪栓子。注射后 3 天拍摄的图像显示视盘苍白，视网膜血管和玻璃体内有脂肪栓塞，黄斑内有小的离散黄色渗出物样病变，与临床上看到的脂肪颗粒一致（图 1）。谱域光学相干断层扫描显示玻璃体中的高反射沉积物，与临床上看到的脂肪颗粒一致（图 2）。玻璃体内脂肪颗粒的发病机制尚不清楚，但推测与视网膜毛细血管闭塞和视网膜内萎缩有关。该患者最初接受了药物治疗以降低眼内压。随后的随访中，患者出现晚期视网膜纤维化、血管硬化和视神经萎缩。鉴于视力、严重视神经萎缩、视网膜缺血和纤维化，推定诊断为眼动脉闭塞（患者拒绝静脉荧光素血管造影）。尽管罕见，但仍有几例面部自体脂肪注射后出现眼部并发症的病例报告。 1–5
A23-year-old woman underwent autologous unpurified fat injection into the left lateral aspect of her nose for aesthetic soft tissue augmentation. Within 90 minutes, she presented with no light perception in the left eye. There was a Grade V left relative afferent pupillary defect. On examination of the left fundus, there was extensive retinal whitening, a cherry-red spot, arteriolar box caring, and multiple fat emboli in the retinal arterioles. Images taken 3 days post injection reveal optic disk pallor, fat emboli in the retinal blood vessels and vitreous, and small discrete yellow exudatelike lesions in the macula in keeping with fat particles seen clinically (Figure 1). Spectral domain optical coherence tomography displays highly reflective deposits in the vitreous in keeping with fat particles seen clinically (Figure 2). The pathogenesis of fat particles in the vitreous is not well understood but postulated to be related to retinal capillary obliteration and inner retinal atrophy. The patient was initially treated medically to lower intraocular pressure. On subsequent follow-up, the patient displayed advanced retinal fibrosis, vessel sclerosis, and optic atrophy. Given the visual acuity, severe optic atrophy, retinal ischemia, and fibrosis, a presumptive diagnosis of ophthalmic artery occlusion was made (patient declined intravenous fluorescein angiography). Although rare, there are several case reports of ocular complications after facial autologous fat injections. 1–5