Acute Paracentral Scotoma Following Cosmetic Penile Filler Injection

PURPOSE: To describe macular ischemia following cosmetic penile filler injection due to presumed branch retinal artery occlusion from embolization through a patent foramen ovale (PFO). METHODS: Multimodal imaging, including fundus photography, spectral domain optical coherence tomography (OCT), OCT angiography (OCTA), and fluorescein angiography (FA) were performed. RESULTS: A 33-year-old healthy male presented with an acute paracentral scotoma of the left eye (OS) shortly after undergoing an elective cosmetic penile filler injection. Retinal examination and color fundus photography illustrated a cotton wool spot corresponding to the acute scotoma OS. Spectral domain OCT showed corresponding hyperreflectivity of the inner and middle retina OS and paracentral acute middle maculopathy (PAMM). OCTA of the superficial and deep capillary plexus showed corresponding flow deficit and fluorescein angiography illustrated corresponding segmental staining of the retinal arterioles in the macula suggestive of branch retinal artery occlusion (BRAO) OS. Extensive systemic evaluation was unremarkable except for transthoracic echocardiography, which revealed a PFO. Brain magnetic resonance imaging (MRI) was normal and infectious, inflammatory, and hypercoagulable workups were negative. CONCLUSION: and Importance: This report highlights a case of occlusive vascular maculopathy following distal cosmetic filler injection likely mediated by embolization through a PFO. Arterial occlusive events can occur after elective cosmetic procedures and patients should be counselled accordingly.