title: Vancomycin-Associated Hemorrhagic Occlusive Retinal Vasculitis: Clinical Characteristics of 36 Eyes.
abstract: To expand understanding of presentation, diagnosis, and outcomes of hemorrhagic occlusive retinal vasculitis (HORV).
  
  
  
  Retrospective case series.
  
  
  
  Thirty-six eyes of 23 patients.
  
  
  
  The American Society of Cataract and Refractive Surgery (ASCRS) and the American Society of Retina Specialists (ASRS) formed a joint task force to define clinical characteristics of HORV and to study its prevalence, cause, treatment, and outcomes. An online registry was established on both societies' web sites. Surveys were e-mailed to members of both societies soliciting cases of suspected HORV. A literature search was performed to uncover additional cases.
  
  
  
  Historical data including intraoperative characteristics, images, treatment regimens, and visual and anatomic outcomes.
  
  
  
  Characteristic findings of HORV included unremarkable postoperative day 1 undilated examination, delayed-onset painless vision loss, mild anterior chamber and vitreous inflammation, sectoral retinal hemorrhages in areas of ischemia, and predilection for venules and peripheral involvement. Based on predetermined diagnostic criteria, 36 eyes of 23 patients were diagnosed with HORV. All eyes received intraocular vancomycin via intracameral bolus (33/36), via intravitreal injection (1/36), or through the irrigation bottle (2/36). Patients sought treatment with HORV 1 to 21 days after surgery or intravitreal injection. Visual results usually were poor: 22 of 36 eyes (61%) had 20/200 or worse visual acuity and 8 of 36 eyes (22%) had no light perception (NLP). Neovascular glaucoma developed in 20 of 36 eyes (56%). Seven eyes received additional intravitreal vancomycin after surgery; 5 of these 7 eyes had NLP visual acuity at the most recent examination. Three eyes received intravitreal corticosteroids and had final visual acuities of 20/40, 20/70, and hand movements.
  
  
  
  Hemorrhagic occlusive retinal vasculitis is a rare, potentially devastating condition that can develop after cataract surgery or intraocular injection. All cases in this series were associated with intraocular vancomycin. Disease course and findings suggest that HORV is caused by a delayed hypersensitivity reaction to vancomycin. Early treatment with corticosteroids likely is beneficial. Subsequently, anti-vascular endothelial growth factor injections and panretinal photocoagulation are important to prevent neovascular glaucoma, a common complication. Avoidance of additional intravitreal vancomycin is recommended if HORV is suspected.
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: Department of Ophthalmology, University of California, San Francisco, San Francisco, California.
authors.forename: David F
authors.initials: DF
authors.lastname: Chang
authors.affiliation: West Coast Retina, San Francisco, California.
authors.forename: J Michael
authors.initials: JM
authors.lastname: Jumper
authors.affiliation: Charles Retina Institute, Germantown, Tennessee.
authors.forename: Steve
authors.initials: S
authors.lastname: Charles
authors.affiliation: Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts.
authors.forename: Dean
authors.initials: D
authors.lastname: Eliott
authors.affiliation: Oregon Eye Associates, Eugene, Oregon.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Hoffman
authors.affiliation: Department of Ophthalmology, University of Utah, Salt Lake City, Utah.
authors.forename: Nick
authors.initials: N
authors.lastname: Mamalis
authors.affiliation: Stein Eye Institute and Department of Ophthalmology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Miller
authors.affiliation: Retina Consultants of Houston, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas.
authors.forename: Charles C
authors.initials: CC
authors.lastname: Wykoff
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects; D002387:Cataract Extraction / Q000009:adverse effects; D005260:Female; D005451:Fluorescein Angiography; D005654:Fundus Oculi; D006801:Humans; D058449:Intravitreal Injections / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D012160:Retina / Q000187:drug effects / Q000473:pathology; D012166:Retinal Hemorrhage / Q000139:chemically induced* / Q000175:diagnosis; D031300:Retinal Vasculitis / Q000139:chemically induced* / Q000175:diagnosis; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000517:prevention & control; D041623:Tomography, Optical Coherence; D014640:Vancomycin / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin