Ophthalmic Artery Occlusion and Subsequent Retinal Fibrosis From a Calcium Hydroxylapatite Filler Injection

We report a case of an otherwise healthy 48-year-old woman presenting with acute vision loss after injection of a soft-tissue filler in the glabellar region with calcium hydroxylapatite microspheres (Radiesse, Merz North America, Inc) with 9 months of follow-up. Fundus photographs and spectral-domain optical coherence tomography (SD-OCT) were obtained at presentation, at 4 months of follow-up, and at 9 months of follow-up. Acutely, the retina was characterized by significant pallor and thickening but evolved into diffuse retinal fibrosis and atrophy. The patient had no light perception at presentation and did not recover any visual function. Few case reports have described calcium hydroxylapatite filler injections leading to orbital and ocular complications. This is the first case report illustrating dense fibrotic and atrophic retinal changes on fundus photography, fluorescein angiography, and SD-OCT. While various facial fillers have been reported to have serious ocular consequences, we illustrate the acute and subsequent sequelae of an ophthalmic artery occlusion from calcium hydroxylapatite microspheres