Vancomycin-Associated Hemorrhagic Occlusive Retinal Vasculitis: A Clinical-Pathophysiological Analysis

Area of Science:

• Ophthalmology
• Pathology
• Retinal Diseases

Background:

• Vancomycin-related hemorrhagic occlusive retinal vasculopathy (HORV) is a rare but severe condition.
• Understanding its pathophysiology is crucial for diagnosis and management.

Observation:

• Two patients with HORV post-cataract surgery presented with vision loss and pain.
• Clinicopathologic correlation included multimodal imaging, UBM, and histology.
• Histology showed iris/ciliary body infarction, hemorrhagic retinal necrosis, and occlusive choroidal vasculopathy.

Findings:

• HORV involves necrotizing retinal vasculopathy without retinal vasculitis.
• Chronic nongranulomatous choroiditis with T-cell infiltration was observed.
• A unique glomeruloid endothelial cell proliferation was noted in the choroid.

Implications:

• HORV pathophysiology is complex, differing from leukocytoclastic retinal vasculitis.
• Ocular pain may indicate severe ciliary body ischemia in HORV.
• These findings refine understanding of this vision-threatening condition.