Injection of vancomycin during cataract surgery may rarely be associated with hemorrhagic occlusive retinal vasculitis (HORV).

Patient selection: vancomycin injection into the anterior chamber (intracameral) during cataract surgery


Clinical presentation:

(1) onset of symptoms within 1 month of an otherwise uncomplicated cataract surgery

(2) loss of vision, which may be progressive

(3) variable ocular pain, often painless

(4) mild anterior segment and vitreous inflammation

(5) hemorrhagic vascular occlusion affecting the retinal periphery and macula with sectoral, large and/or confluent retinal hemorrhages

(6) variable macular and peripheral vascular nonperfusion on fluorescein angiography

(7) thickening of the inner retinal layers without cystoid macular edema on optical coherence tomography

(8) variable ischemia of the iris and ciliary body


Differential diagnosis:

(1) endophthalmitis


Histologic features:

(1) necrotizing retinal vasculopathy with variable tissue infarction

(2) absence of retinal vasculitis

(3) chronic nongranulomatous choroiditis

(4) glomeruloid proliferation of small blood vessels (choroid, elsewhere)

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