Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Mar 24;87(4):e2022-0132.
doi: 10.5935/0004-2749.2022-0132. Online ahead of print.

Vancomycin-associated hemorrhagic occlusive retinal vasculitis masquerading as central retinal vein occlusion

Virginia Mares  1 , Carlos Eduardo Dos Reis Veloso  1 , Marcio Bittar Nehemy  1
Affiliations

Vancomycin-associated hemorrhagic occlusive retinal vasculitis masquerading as central retinal vein occlusion

Virginia Mares et al. Arq Bras Oftalmol. .

Abstract
in English, Portuguese

A 69-year-old female was referred with sudden unilateral painless decreased vision that began 2 days after uncomplicated cataract surgery in the left eye. Visual acuity was hand motion and biomicroscopy showed a mild anterior chamber reaction, no hypopyon, and an intraocular lens that had been placed within the capsular bag. A dilated fundus examination revealed optic disk edema, widespread deep and superficial intraretinal hemorrhages, retinal ischemia, and macular edema. A cardiological evaluation was normal and thrombophilia tests were negative. After surgery, prophylactic vancomycin (1mg/0.1ml) had been injected intracamerally. The patient was diagnosed with hemorrhagic occlusive retinal vasculitis likely secondary to vancomycin hypersensitivity. Recognition of this entity is important to ensure early treatment and the use of intracameral vancomycin in the fellow eye should be avoided after cataract surgery.

Esse caso se refere a uma paciente de 69 anos, sexo feminino, com relato de baixa acuidade visual súbita e indolor no olho esquerdo, de início 2 dias após cirurgia de catarata sem complicações. A acuidade visual era de movimento de mãos e a biomicroscopia mostrou reação de câmara anterior moderada, sem hipópio, e lente intraocular posicionada dentro do saco capsular. A fundoscopia evidenciou edema de disco óptico, hemorragias difusas intrarretinianas superficiais e profundas, isquemia retiniana e edema macular. A avaliação cardiológica foi normal e os testes para trombofilia foram negativos. Ao final da cirurgia foi injetado antibioticoprofilaxia com vancomicina (1mg/0,1ml) na câmara anterior. A paciente foi diagnosticada com vasculite hemorrágica oclusiva da retina secundária à hipersensibilidade a vancomicina. O reconhecimento dessa entidade é importante para o tratamento precoce e para evitar o uso de vancomicina intracameral em caso de cirurgia de catarata no olho contralateral.

PubMed Disclaimer

Conflict of interest statement

Disclosure of potential conflicts of interest: None of the authors have any potential conflicts of interest to disclose.

Figures

Figure 1
Figure 1
A pan-retinal fundus image of the eye of a patient with hemorrhagic occlusive retinal vasculitis showing edema of the optic disc, widespread deep and superficial hemorrhages, and macular edema.
Figure 2
Figure 2
Fluorescein angiography image from a patient with hemorrhagic occlusive retinal vasculitis showing peripheral vasculitis and the near--complete absence of retinal perfusion, including the macula.
Figure 3
Figure 3
Fluorescein angiography image from a patient with hemorrhagic occlusive retinal vasculitis showing pan-retinal photocoagulation and macular ischemia.
See this image and copyright information in PMC

References

    1. Taban M, Behrens A, Newcomb RL, Nobe MY, Saedi G, Sweet PM, et al. Acute endophthalmitis following cataract surgery: A systematic review of the literature. Arch Ophthalmol. 2005;123(5):613–620. - PubMed
    1. Endophthalmitis Study Group, European Society of Cataract & Refractive Surgeons Prophylaxis of postoperative endophthalmitis following cataract surgery: Results of the ESCRS multicenter study and identification of risk factors. J Cataract Refract Surg. 2007;33(6):978–988. Comment in: J Cataract Refract Surg. 2008;34(1):9-10. - PubMed
    1. Barry P, Cordoves L, Gardner S. ESCRS guidelines for prevention and treatment of endophthalmitis following cataract surgery: Data, dilemmas and conclusions [Internet] Dublin, Ireland: European Society of Cataract and Refractive Surgeons; 2013. [2020 Jul 27]. Available from: Endophthalmitis-Guidelines.pdf (escrs.org)
    1. Chang DF, Braga-Mele R, Henderson BA, Mamalis N, Vasavada A, ASCRS Cataract Clinical Committee Antibiotic prophylaxis of postoperative endophthalmitis after cataract surgery: Results of the 2014 ASCRS member survey. J Cataract Refract Surg. 2015;41(6):1300–1305. - PubMed
    1. Braga-Mele R, Chang DF, Henderson BA, Mamalis N, Talley-Rostov A, Vasavada A, ASCRS Clinical Cataract Committee Intracameral antibiotics: Safety, efficacy, and preparation. J Cataract Refract Surg. 2014;40(12):2134–2142. - PubMed

LinkOut - more resources