Iatrogenic ocular ischemic syndrome combined with central retinal artery occlusion following periorbital aesthetic Poly‐D, L‐lactic acid filler injections – a case report

INTRODUCTION: Poly-D, L-lactic acid (PDLLA), a new dermal filler, has gained popularity in cosmetic surgery due to its biodegradability, safety, and rejuvenating effects. While the literature has primarily focused on dermal reactions as side effects of PDLLA injections, ophthalmic complications are rarely mentioned. CASE DESCRIPTION: We describe a presentation of severe visual loss and ophthalmalgia in a patient after injection with PDLLA subcutaneous filler at the nasal region who had been diagnosed with right eye iatrogenic ocular ischemic syndrome combined with central retinal artery occlusion. Despite treatment with ocular massage, intravitreal Aflibercept injection, and Hyperbaric Oxygen Therapy, her vision remained persistently impaired. DISCUSSION AND CONCLUSION: This appears to be the first reported case of iatrogenic ocular ischemic syndrome combined with central retinal artery occlusion following PDLLA subcutaneous filler treatment. We emphasize the importance of understanding facial arterial anatomy and raise awareness of this rare visual complication associated with PDLLA.