POSTOPERATIVE HEMORRHAGIC OCCLUSIVE RETINAL VASCULITIS: A FORME FRUSTE VARIANT?

To present a forme fruste variant of hemorrhagic occlusive retinal vasculitis (HORV) after uncomplicated cataract surgery performed with vancomycin in the irrigating solution.

A report of a single patient who developed HORV; the clinical features and course are described and compared with previously reported cases.

Ultra-widefield fluorescein angiography demonstrated an occlusive vasculitis in both eyes 1 week after uncomplicated cataract surgery in which vancomycin was added to the irrigating solution. An extensive systemic evaluation including a hypercoagulable workup, serum electrophoresis, complete blood count, and carotid and cardiac ultrasound was negative. Visual acuity was unaffected, and the patient remained 20/20 in each eye one year after surgery without treatment. This is a markedly different outcome than seen in previously reported cases of HORV.

Ultra-widefield angiography was helpful to confirming the diagnosis of HORV in this milder case example in a patient who maintained excellent vision. This forme fruste variant of HORV after exposure to vancomycin suggests that the incidence of HORV after cataract surgery may be more common than previously reported. Vigilance, close observation, and broad reporting can help further clarify the incidence and potential adverse effects of routinely using intracameral vancomycin during cataract surgery.