A Case of Successful Visual Restoration Following Cilioretinal Artery Occlusion Secondary to Biostimulator Filler Injection

Biostimulator fillers are increasingly used in cosmetic and regenerative medicine because of their collagen-stimulating properties; however, ocular vascular occlusion remains a rare but potentially devastating complication. We report a case of isolated cilioretinal artery occlusion following periocular injection of poly-D,L-lactic acid with carboxymethylcellulose (PDLLA-CMC), with favorable visual recovery after prompt multidisciplinary treatment. A 52-year-old Chinese woman with a history of facial fat grafting, direct brow lift surgery, and previous polycaprolactone filler treatment underwent PDLLA-CMC injections to the temples and forehead. Using a 22-gauge, 50-mm blunt cannula, 3 mL of reconstituted product was injected on each side via a supraperiosteal fanning technique. Immediately after right temporal injection, she experienced dark spots in the right visual field. An emergency vascular occlusion protocol was initiated, including supine positioning, ocular massage, high-flow oxygen, topical timolol and brimonidine, oral acetazolamide and aspirin, and intravenous dexamethasone. Urgent ophthalmologic assessment demonstrated best-corrected visual acuity of 6/6 in both eyes, visible emboli within the right cilioretinal artery, inner retinal edema in the inferonasal parafoveal region on optical coherence tomography, and a corresponding paracentral scotoma on Humphrey visual field testing. Oral prednisolone and hyperbaric oxygen therapy were commenced early. Hyperbaric oxygen was delivered at 2.2–2.4 atmospheres absolute with 100% oxygen for 90 min twice daily for 2 days, followed by daily sessions for 1 week. Over 4 weeks, the patient reported progressive symptomatic improvement, while serial fundus imaging and visual field testing demonstrated embolus displacement, reduction of retinal edema, and improvement of the scotoma, with visual acuity remaining 6/6 throughout follow-up. This case highlights that isolated cilioretinal artery occlusion can occur after PDLLA-CMC injection despite recommended technique, and suggests that immediate recognition, early ophthalmologic referral, and adjunctive hyperbaric oxygen therapy may improve outcomes in non-hyaluronic acid filler-related ocular ischemic events when instituted without delay in carefully selected acute presentations.