Postoperative Hemorrhagic Occlusive Retinal Vasculitis: Expanding the Clinical Spectrum and Possible Association with Vancomycin.

PURPOSE: To describe a syndrome of hemorrhagic occlusive retinal vasculitis (HORV) that developed after seemingly uncomplicated cataract surgery. DESIGN: Retrospective case series. SUBJECTS: Eleven eyes of 6 patients from 6 different institutions. METHODS: Cases were identified after discussion among retina specialists. The findings on presentation, clinical course, and outcome of a series of 7 eyes of 4 patients were compared with a previous report of 4 eyes of 2 patients, and data from both series were combined for a comprehensive analysis. MAIN OUTCOME MEASURES: Historical data, examination findings, imaging results, systemic evaluation findings, treatment regimens, and visual outcomes. RESULTS: Eleven eyes of 6 patients underwent otherwise uncomplicated cataract surgery, receiving viscoelastic and prophylactic intracameral vancomycin during the procedure. Despite good initial vision on postoperative day 1, between 1 to 14 days after surgery, all eyes demonstrated painless vision loss resulting from HORV. Extensive ocular and systemic evaluations were unrevealing in all patients. All patients were treated with aggressive systemic and topical corticosteroids. Additional treatments included systemic antiviral medication in 4 patients, intravitreal antibiotics in 4 eyes, and pars plana vitrectomy in 4 eyes. Skin testing for vancomycin sensitivity showed negative results in 3 patients and was not performed in the others. Neovascular glaucoma developed in 7 eyes, and all eyes received intravitreal anti-vascular endothelial growth factor (VEGF) injection, panretinal photocoagulation, or both for retinal ischemia. Final visual acuity was less than 20/100 in 8 of 11 eyes. CONCLUSIONS: Postoperative HORV is an exceedingly rare and potentially devastating condition that can occur after otherwise uncomplicated cataract surgery. Although the precise cause remains unknown, this disease may represent a delayed immune reaction similar to vancomycin-induced leukocytoclastic vasculitis. Despite treatment with high-dose corticosteroids, antiviral medication, and early vitrectomy in many patients, visual outcomes typically were poor in this series. Early intervention with intravitreal anti-VEGF medication and panretinal photocoagulation may help to prevent additional vision loss resulting from neovascular glaucoma.

Combined central retinal vein and central retinal artery occlusions and neovascular glaucoma associated with interferon treatment.

PURPOSE: Interferon (IFN) is a mainstay medication used for treatment of chronic hepatitis C, as well as for treatment of certain neoplastic and autoimmune conditions. We present a case of a 50-year-old man who, while on IFN treatment, developed central retinal vein and artery occlusions complicated by the development of neovascular glaucoma secondary to severe retinal ischemia. Interferon retinopathy is associated with ischemic retinal cotton-wool spots. This case illustrates how IFN can lead to severe and sight-threatening retinal ischemia. METHODS: Case report. RESULTS: A 50-year-old man with previously good vision presented with decreased vision in the right eye while being treated with IFN therapy for chronic hepatitis C. He was diagnosed with central retinal vein occlusion and 2 weeks later also developed a central retinal artery occlusion. His course was complicated by the development of neovascular glaucoma. The final visual acuity was ultimately light perception. CONCLUSIONS: Interferon therapy is commonly utilized for chronic hepatitis C, neoplastic conditions, and multiple sclerosis. Clinicians should be aware of the sight-threatening complications of IFN therapy, especially with regard to ocular vaso-occlusive disease and severe retinal ischemia.