Pars Plana Vitrectomy for Inadvertent Intravitreal Injection of Hyaluronic Acid Dermal Filler: A Case Report

Introduction: Hyaluronic acid (HA) dermal fillers are commonly used in cosmetic practice and are generally safe; however, ocular complications may occur if material is introduced into periocular or intraocular structures. Although vascular-related vision loss has been widely reported, direct intravitreal dermal filler deposition is exceedingly rare, and subsequent management with vitrectomy has not been previously documented. This report presents the clinical course and management of inadvertent intravitreal injection of HA filler and highlights considerations for safe removal. Case Presentation: A 47-year-old woman experienced immediate, transient vision loss following temporal filler injection with HA-based cosmetic filler (i.e., Juvéderm Voluma), with partial spontaneous recovery within minutes. She presented days later with persistent blurred vision and a mobile opacity within the vitreous cavity. Multimodal imaging demonstrated a scintillating intravitreal deposit consistent with HA filler. After initial management with topical corticosteroids and close observation, worsening visual acuity and persistent blurred vision prompted prophylactic puncture site laser retinopexy and uncomplicated 25-gauge pars plana vitrectomy. Postoperatively, visual acuity improved to 20/20, intraocular pressure remained stable, and retinal architecture was preserved without evidence of inflammation or toxicity. Conclusion: This case highlights a rare mechanism of ocular injury related to cosmetic filler injection. The highly cross-linked nature of modern HA fillers likely limits spontaneous degradation within the vitreous, making surgical removal a reasonable consideration in symptomatic patients. Prompt recognition and appropriate ophthalmic referral are essential. While primary prevention of such complications is paramount, pars plana vitrectomy can be safely and effectively performed to restore vision and mitigate long-term retinal risk in select cases.