title: Postoperative Hemorrhagic Occlusive Retinal Vasculitis: Expanding the Clinical Spectrum and Possible Association with Vancomycin.
abstract: OBJECTIVE
  To describe a syndrome of hemorrhagic occlusive retinal vasculitis (HORV) that developed after seemingly uncomplicated cataract surgery.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Eleven eyes of 6 patients from 6 different institutions.
  
  
  METHODS
  Cases were identified after discussion among retina specialists. The findings on presentation, clinical course, and outcome of a series of 7 eyes of 4 patients were compared with a previous report of 4 eyes of 2 patients, and data from both series were combined for a comprehensive analysis.
  
  
  METHODS
  Historical data, examination findings, imaging results, systemic evaluation findings, treatment regimens, and visual outcomes.
  
  
  RESULTS
  Eleven eyes of 6 patients underwent otherwise uncomplicated cataract surgery, receiving viscoelastic and prophylactic intracameral vancomycin during the procedure. Despite good initial vision on postoperative day 1, between 1 to 14 days after surgery, all eyes demonstrated painless vision loss resulting from HORV. Extensive ocular and systemic evaluations were unrevealing in all patients. All patients were treated with aggressive systemic and topical corticosteroids. Additional treatments included systemic antiviral medication in 4 patients, intravitreal antibiotics in 4 eyes, and pars plana vitrectomy in 4 eyes. Skin testing for vancomycin sensitivity showed negative results in 3 patients and was not performed in the others. Neovascular glaucoma developed in 7 eyes, and all eyes received intravitreal anti-vascular endothelial growth factor (VEGF) injection, panretinal photocoagulation, or both for retinal ischemia. Final visual acuity was less than 20/100 in 8 of 11 eyes.
  
  
  CONCLUSIONS
  Postoperative HORV is an exceedingly rare and potentially devastating condition that can occur after otherwise uncomplicated cataract surgery. Although the precise cause remains unknown, this disease may represent a delayed immune reaction similar to vancomycin-induced leukocytoclastic vasculitis. Despite treatment with high-dose corticosteroids, antiviral medication, and early vitrectomy in many patients, visual outcomes typically were poor in this series. Early intervention with intravitreal anti-VEGF medication and panretinal photocoagulation may help to prevent additional vision loss resulting from neovascular glaucoma.
authors.affiliation: Department of Ophthalmology, Tufts Medical Center, New England Eye Center, Boston, Massachusetts. Electronic address: ajwitkin@gmail.com.
authors.forename: Andre J
authors.initials: AJ
authors.lastname: Witkin
authors.affiliation: Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan.
authors.forename: Anjali R
authors.initials: AR
authors.lastname: Shah
authors.affiliation: Valley Retina Associates, Encino, California.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Engstrom
authors.affiliation: Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Kron-Gray
authors.affiliation: Department of Ophthalmology, Tufts Medical Center, New England Eye Center, Boston, Massachusetts.
authors.forename: Caroline R
authors.initials: CR
authors.lastname: Baumal
authors.affiliation: Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Johnson
authors.affiliation: Department of Ophthalmology, Tufts Medical Center, New England Eye Center, Boston, Massachusetts.
authors.forename: Deborah I
authors.initials: DI
authors.lastname: Witkin
authors.affiliation: Allergy Division, Tufts Medical Center, Boston, Massachusetts.
authors.forename: John
authors.initials: J
authors.lastname: Leung
authors.affiliation: Bascom Palmer Eye Institute, University of Miami, Miami, Florida.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Albini
authors.affiliation: Bascom Palmer Eye Institute, University of Miami, Miami, Florida.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Moshfeghi
authors.affiliation: Retina Associates PA, Shawnee Mission, Kansas.
authors.forename: Ivan R
authors.initials: IR
authors.lastname: Batlle
authors.affiliation: Massachusetts Eye and Ear Infirmary, Retina Service, Harvard Medical School, Boston, Massachusetts.
authors.forename: Lucia
authors.initials: L
authors.lastname: Sobrin
authors.affiliation: Massachusetts Eye and Ear Infirmary, Retina Service, Harvard Medical School, Boston, Massachusetts.
authors.forename: Dean
authors.initials: D
authors.lastname: Eliott
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects*; D002387:Cataract Extraction; D003131:Combined Modality Therapy; D009877:Endophthalmitis / Q000517:prevention & control; D005260:Female; D005451:Fluorescein Angiography; D015355:Glaucoma, Neovascular / Q000139:chemically induced / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D058449:Intravitreal Injections; D017075:Laser Coagulation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012166:Retinal Hemorrhage / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D031300:Retinal Vasculitis / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D014640:Vancomycin / Q000008:administration & dosage / Q000009:adverse effects*; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity
chemical_list: D020533:Angiogenesis Inhibitors; D000900:Anti-Bacterial Agents; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D014640:Vancomycin