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Ophthalmic Images
September 10, 2020

Hemorrhagic Occlusive Retinal Vasculitis Following Prophylactic Intraocular Vancomycin Injection

Author Affiliations
  • 1LV Prasad Eye Institute, Hyderabad, India
JAMA Ophthalmol. 2020;138(9):e195673. doi:10.1001/jamaophthalmol.2019.5673

A woman in her 60s presented with profound visual acuity loss in her right eye 1 week after cataract surgery. Her visual acuity was limited to hand motions close to the face, and she had sluggish pupils. She had undergone uneventful cataract surgery with 1 mg of intracameral vancomycin for prophylaxis of endophthalmitis. Subconjunctival antibiotics were not used. A clinical diagnosis of hemorrhagic occlusive retinal vasculitis (HORV) was made.

Hemorrhagic occlusive retinal vasculitis is a sight-threatening complication associated with the use of intracameral vancomycin.1 The exact pathogenesis is unknown; however, the reaction is postulated to be leukocytoclastic and involve necrotizing retinal vasculopathy.2 The relatively uninvolved area of the patient’s inferior macula (Figure) is suggestive of an area of pathological sparing wherein perfusion of the inner retina may have been dependent on a cilioretinal artery rather than a branch of the central retinal artery.

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