Multifocal strokes and vision loss from PDLLA filler injections

Area of Science:

• Neurology
• Ophthalmology
• Dermatology

Background:

• Poly-D, L-lactic acid (PDLLA) is a popular cosmetic dermal filler known for its longevity.
• Vascular complications associated with PDLLA fillers are increasingly reported.
• This study details the first reported instance of multifocal strokes linked to PDLLA cosmetic injections.

Observation:

• A patient experienced sudden bilateral vision loss post-PDLLA injections in the nasolabial and infraorbital areas.
• Ophthalmoscopy revealed retinal edema and filler material in retinal arteries.
• Brain MRI confirmed multifocal strokes and left optic nerve ischemia.

Findings:

• The patient's neurological and ophthalmological symptoms were attributed to PDLLA embolism within the intracranial arterial system.
• This case demonstrates a rare but severe vascular complication of cosmetic PDLLA filler use.
• Treatment with hyperbaric oxygen therapy resulted in partial visual recovery.

Implications:

• Physicians must be aware of potential vascular complications, including stroke and vision loss, associated with PDLLA fillers.
• Early recognition and prompt management are critical for improving outcomes in patients experiencing filler-related vascular events.
• Despite its general safety profile, the increasing use of PDLLA necessitates vigilance regarding its potential for serious adverse events.