Postoperative Hemorrhagic Occlusive Retinal Vasculitis Associated with Intravitreal Injection of Vancomycin

Sónia Parreira,Gabriel Andrade,Cristina Muccioli,Heloisa Nascimento

doi:10.15234/vpa.v17i3.497

Abstract

PURPOSE: To present a case of hemorrhagic occlusive retinal vasculitis (HORV) associated with intravitreal injection of vancomycin after pars plana vitrectomy (PPV).METHODS: Single case report.RESULTS: A 67-year-old woman presented with best corrected visual acuity (BCVA) of 20/400 in left eye. For clinical suspicion of chronic endophthalmitis, empirical treatment was initiated with vancomycin and ceftazidime without clinical improvement. The patient was submitted to pars plana vitrectomy. During surgery rhegmatogenous retinal detachment was observed and treated. At the end of surgery, intravitreal vancomycin was injected. After 18 days BCVA was counting fingers and fundus examination showed diffuse retinal vascular sheathing, intraretinal hemorrhages and ischemic macular whitening. The clinical diagnosis was compatible with HORV secondary to retinal toxicity due to intraocular vancomycin.CONCLUSIONS: This case illustrates the importance of including intravitreal vancomycin during PPV surgery on the list of potential causes when investigating a case of suspected hemorrhagic occlusive retinal vasculitis.

Highlights

Vancomycin is a broad-spectrum antibiotic that covers most staphylococcal and streptococcal species, which are the most frequent causes of postoperative Case ReportA 67-year-old white woman with a past medical history of hypertension presented at the Department of Ophthalmology with complaints of progressive, painless vision loss in her left eye for the last two months
Intravitreal injection of vancomycin is a well-established treatment for bacterial endophthalmitis and has been shown to be safe for intraocular use at a dose of 1.0 mg/0.1 ml.[3]
Vancomycin retinal toxicity has been demonstrated in rabbits receiving intravitreal injections of vancomycin in silicone-filled eyes, but human toxicity has not been suggested until recently

Summary

Introduction

For clinical suspicion of chronic endophthalmitis aqueous and vitreous samples were collected for analysis and empirical treatment was initiated with intravitreal injection of vancomycin (1 mg/0.1 mL) and ceftazidime (2.25mg/0.1mL). It was prescribed moxifloxacin and dexamethasone drops every 2 hours. After one week, her vision was 20/800, IOP was 14mmHg, and there was more inflammatory reaction in the anterior and vitreous chamber (3+/4). On postoperative day 1, her vision was hand motion; slit-lamp examination revealed moderated conjunctival injection with fibrin in the anterior chamber, and retinal examination was impossible by severe vitreous opacities.

Results

Discussion

Conclusion