Vancomycin-Associated Hemorrhagic Occlusive Retinal Vasculitis

Emerging Worldwide Antimicrobial Resistance, Antibiotic Stewardship and Alternative Intravitreal Agents for the Treatment of Endophthalmitis

“…20 , 24 - 27 Hemorrhagic occlusive retinal vasculitis (HORV) is a poorly understood but potentially devastating complication associated with intracameral vancomycin. 28 Antibiotic stewardship programs seek to mitigate these concerns.…”

Intracameral Antibiotics in the Shadow of Hemorrhagic Occlusive Retinal Vasculitis

“…1 The dramatic fundus images and poor visual outcomes are enough to give any surgeon pause. For surgeons hesitant about using intracameral antibiotics (ICAs), HORV may represent confirmation that ophthalmologists should avoid ICAs altogether.…”

“…If vancomycin were the only ICA available, the description of HORV by Witkin et al 1 would make anyone hesitant to consider its regular use, although HORV seems to be an extremely rare condition. As reported in the American Society of Cataract & Refractive Surgery (ASCRS) surveys of POE prophylaxis, many surgeons have used intracameral vancomycin routinely.…”

“…11,14 It is possible that cases of HORV were either misdiagnosed or not recognized in prior studies of intra-cameral vancomycin, perhaps in part because HORV is so uncommon. Nonetheless, after the creation of a joint task force with member solicitation of large cataract and retina societies, Witkin et al 1 report HORV in 36 eyes of 23 patients worldwide spanning an 11-year period. By contrast, it has been estimated that the expanded use of ICAs could prevent 2000 cases of POE annually in the United States alone.…”

“…As to which antibiotic to choose, the recent report by Witkin et al 1 should prompt a re-evaluation of the role of vancomycin in routine endophthalmitis prophylaxis. The choice between the remaining most popular current options, cefuroxime and moxifloxacin, may depend on the historical infection profile of the surgery center and sourcing capabilities.…”