Vancomycin-Associated Hemorrhagic Occlusive Retinal Vasculitis: A Case Series and Systematic Review

Area of Science:

• Ophthalmology
• Retinal Vascular Diseases
• Ophthalmic Surgery

Background:

• Hemorrhagic occlusive retinal vasculitis (HORV) is a rare but severe complication following cataract surgery.
• Understanding risk factors and effective treatments is crucial for preserving vision.

Purpose of the Study:

• To describe three new cases of unilateral HORV post-cataract surgery.
• To review existing literature on HORV, analyzing patient data and outcomes.
• To recommend improved management strategies for HORV.

Main Methods:

• Case series of three unilateral HORV patients after cataract surgery.
• Systematic literature review of HORV cases until February 2022.
• Analysis of 61 eyes from 41 patients (20 bilateral, 21 unilateral HORV).

Main Results:

• HORV occurred a mean of 9 days post-surgery; 7 days between surgeries in bilateral cases.
• 48% had visual acuity < 20/400; 20% had no light perception.
• Neovascular glaucoma developed in 43%; central macular changes on OCT correlated with worse outcomes.
• Additional vancomycin use was linked to poorer outcomes.

Conclusions:

• HORV post-cataract surgery is associated with significant visual impairment and glaucoma.
• Early intervention with corticosteroids, laser photocoagulation, or anti-VEGF therapy may be beneficial.
• Exploring prophylactic agents other than vancomycin is warranted.