PARACENTRAL ACUTE MIDDLE MACULOPATHY ASSOCIATED WITH RETINAL ARTERY OCCLUSION AFTER COSMETIC FILLER INJECTION Jayanth Sridhar, MD, Abtin Shahlaee, MD, Wen-Shi Shieh, MD, Ehsan Rahimy, MD Purpose: To report a single case of paracentral acute middle maculopathy in association with retinal artery occlusion in the setting of ipsilateral facial cosmetic filler injection. Methods: Case report. Patient: A 35-year-old woman presenting with sudden vision loss to finger count vision immediately after left nasal fat pad cosmetic filler injection. Results: Dilated funduscopic examination revealed a swollen optic disc with multiple branch arterial occlusions with visible embolic material. Fluorescein angiography confirmed multiple branch arterial occlusions in addition to a focal choroidal infarction in the macula. Spectral-domain optical coherence tomography revealed middle retinal hyperreflectivity in the superotemporal macula consistent with paracentral acute middle maculopathy. En face optical coherence tomography demonstrated a superotemporal area of whitening at the level of the deep capillary plexus corresponding to the paracentral acute middle maculopathy lesion seen on spectral-domain optical coherence tomography. On twelve- month follow-up, final visual acuity was 20/100 due to optic neuropathy. Conclusion: Emboli from cosmetic facial filler injections may rarely result in ipsilateral arterial occlusions and now have a novel association with paracentral acute middle maculopathy likely due to deep capillary plexus feeder vessel occlusion. RETINAL CASES & BRIEF REPORTS 11:S216–S218, 2017 From the Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania. P aracentral acute middle maculopathy (PAMM) is represented by hyperreflectivity within the mid- dle retina on spectral-domain optical coherence tomography (SD-OCT). 1,2 It is presumed to be a secondary sign of deep retinal capillary ischemia and has been associated with multiple retinovascular conditions such as central retinal vein occlusion, retinal artery occlusion, and sickle cell retinopathy. 2– 5 This report details a case of PAMM in conjunction with retinal artery occlusion in the setting of ipsilateral facial cosmetic filler injection, a novel association for this recently described SD-OCT finding. Fig. 1. Montage fundus photograph of the left eye demonstrates mul- tiple branch arterial occlusions (white arrows) with large areas of retinal whitening (black arrows). None of the authors has any financial/conflicting interests to disclose. Reprint requests: Jayanth Sridhar, MD, Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107; e-mail: jsridhar119@gmail.com S216