Ocular immunology and inflammation · 2026
Hemorrhagic Occlusive Retinal Vasculitis After Therapeutic Intravitreal Vancomycin with Favorable Recovery Following Early Vitrectomy: A Case Report.
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Chen Jing-Yi, Fang Hwa-Shin, Chang Hsia-Yi, Chen Xin-Yuan, Lo Wen-Jung
Аннотация
PURPOSE: To describe a postoperative case most consistent with vancomycin-associated hemorrhagic occlusive retinal vasculitis (HORV) in which early pars plana vitrectomy (PPV), undertaken for presumed endophthalmitis, proved diagnostically decisive, with a favorable visual outcome.
METHODS: Single observational case report.
RESULTS: A 43-year-old man developed blurred vision (best-corrected visual acuity [BCVA], counting fingers) 2 days after uncomplicated phacoemulsification, with corneal edema and severe anterior chamber inflammation. No intracameral vancomycin had been used in his prior surgeries. Presumed acute endophthalmitis was treated with intravitreal vancomycin and ceftazidime. The BCVA worsened to hand motions with hypopyon, prompting urgent 27-gauge PPV. Intraoperatively, diffuse intraretinal hemorrhages with prominent perivenular cuffing, minimal vitreous opacity, discrete whitish powder-like retinal deposits, and absence of purulent membranes or retinal necrosis were noted; aqueous and vitreous samples were negative on aerobic, anaerobic and fungal cultures, and aqueous polymerase chain reaction for Herpes simplex virus 1/2, varicella-zoster virus and cytomegalovirus was negative. The findings were most consistent with HORV rather than fulminant endophthalmitis. With topical corticosteroids and no further intravitreal antibiotics, the hypopyon resolved and BCVA improved to 20/30 by day 78 after vitrectomy, when fluorescein angiography showed residual perivascular leakage and optical coherence tomography showed foveal ellipsoid zone attenuation.
CONCLUSIONS: When severe postoperative inflammation worsens despite empiric intravitreal antibiotics and media opacity limits fundus visualization, early PPV can be diagnostically decisive, allowing the hemorrhagic occlusive vasculitic features of HORV to be recognized directly. Its contribution to the favorable visual outcome in this eye, however, remains uncertain.
METHODS: Single observational case report.
RESULTS: A 43-year-old man developed blurred vision (best-corrected visual acuity [BCVA], counting fingers) 2 days after uncomplicated phacoemulsification, with corneal edema and severe anterior chamber inflammation. No intracameral vancomycin had been used in his prior surgeries. Presumed acute endophthalmitis was treated with intravitreal vancomycin and ceftazidime. The BCVA worsened to hand motions with hypopyon, prompting urgent 27-gauge PPV. Intraoperatively, diffuse intraretinal hemorrhages with prominent perivenular cuffing, minimal vitreous opacity, discrete whitish powder-like retinal deposits, and absence of purulent membranes or retinal necrosis were noted; aqueous and vitreous samples were negative on aerobic, anaerobic and fungal cultures, and aqueous polymerase chain reaction for Herpes simplex virus 1/2, varicella-zoster virus and cytomegalovirus was negative. The findings were most consistent with HORV rather than fulminant endophthalmitis. With topical corticosteroids and no further intravitreal antibiotics, the hypopyon resolved and BCVA improved to 20/30 by day 78 after vitrectomy, when fluorescein angiography showed residual perivascular leakage and optical coherence tomography showed foveal ellipsoid zone attenuation.
CONCLUSIONS: When severe postoperative inflammation worsens despite empiric intravitreal antibiotics and media opacity limits fundus visualization, early PPV can be diagnostically decisive, allowing the hemorrhagic occlusive vasculitic features of HORV to be recognized directly. Its contribution to the favorable visual outcome in this eye, however, remains uncertain.