Postoperative Hemorrhagic Occlusive Retinal Vasculitis: A Forme Fruste Variant?

Abstract

Ultra-widefield angiography was helpful to confirming the diagnosis of HORV in this milder case example in a patient who maintained excellent vision. This forme fruste variant of HORV after exposure to vancomycin suggests that the incidence of HORV after cataract surgery may be more common than previously reported. Vigilance, close observation, and broad reporting can help further clarify the incidence and potential adverse effects of routinely using intracameral vancomycin during cataract surgery.

Intracameral antibiotics for prophylaxis of postoperative endophthalmitis in Australia: a review

“…In Witkin's series vancomycin was injected intracamerally in 34 eyes, and was used in the irrigation solution in two eyes of one patient. The later patient had a mild asymptomatic form of HORV, described as forme fruste HORV . Peripheral retinal haemorrhages and peripheral vasculitis were identified in both eyes.…”

“…In a study evaluating endophthalmitis rates which followed 44 863 eyes treated with vancomycin in the irrigation solution not a single case of HORV was reported . In fact, the only case of HORV associated with vancomycin in the infusion solution was the asymptomatic forme fruste HORV patient mentioned above . Other than being potentially safer, antibiotic instillation via irrigation solution may also be more efficacious in complicated cataract cases.…”

“…The later patient had a mild asymptomatic form of HORV, described as forme fruste HORV. 10,13 Peripheral retinal haemorrhages and peripheral vasculitis were identified in both eyes. The haemorrhages gradually resolved, the patient was asymptomatic and retained normal 6/6 vision in both eyes without any treatment.…”

“…9 In fact, the only case of HORV associated with vancomycin in the infusion solution was the asymptomatic forme fruste HORV patient mentioned above. 13 Other than being potentially safer, antibiotic instillation via irrigation solution may also be more efficacious in complicated cataract cases. This method attained effective intravitreal antibiotic concentrations, compared to bolus dose antibiotic instillation in the context of the posterior capsule is rupture, in porcine eyes.…”

Hemorrhagic Occlusive Retinal Vasculitis After Intracameral Vancomycin Use in Cataract Surgery After Intravenous Exposure

“…Witkin et al [3][4][5][6][7][8][9] collaborated on describing the features and characteristics of hemorrhagic occlusive retinal vasculitis (HORV) secondary to intraocular vancomycin in 36 eyes of 23 patients. We report an interesting case of unilateral HORV, and we describe our management and course of treatment.…”