Hemorrhagic Occlusive Retinal Vasculitis
Hemorrhagic occlusive retinal vasculitis (HORV) is a rare but serious complication characterized by delayed-onset painless vision loss, mild anterior chamber and vitreous inflammation, retinal ischemia with sectoral hemorrhages in areas of ischemia, and predilection for venules and peripheral involvement. The disease was first reported as a complication associated with intraoperative use of intraocular vancomycin in 2015. The mechanism of HORV is presumed to be a delayed hypersensitivity immune response occurring 1‒21 days after surgery. Because of the delayed onset, some patients have experienced bilateral HORV, with the second eye undergoing cataract surgery before the first eye exhibited signs of HORV.
Outcomes are poor despite aggressive corticosteroid therapy and other treatments, with 1 series reporting that 61% of eyes had visual acuity ≤20/200 and 22% had no light perception. When choosing an appropriate antibiotic for intraocular prophylaxis, it is important for the surgeon to consider this rare but severe complication of intraocular vancomycin.
Witkin AJ, Chang DF, Jumper JM, et al. Vancomycin-associated hemorrhagic occlusive retinal vasculitis: clinical characteristics of 36 eyes. Ophthalmology. 2017;124(5):583–595.
Excerpted from BCSC 2020-2021 series: Section 11 - Lens and Cataract. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.