Study finds no link between vancomycin, hemorrhagic occlusive retinal vasculitis
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CHICAGO — An analysis of a large series of cataract surgeries found no association between hemorrhagic occlusive retinal vasculitis and the use of vancomycin in the infusion solution.
“Our review of a large series of cases suggests that 0.02 mg/mL of vancomycin is safe for use as endophthalmitis prophylaxis,” Robert DeBurlo said at the American Academy of Ophthalmology meeting. “This is consistent with our view of the literature indicating only mild cases of HORV with vancomycin in the infusion solution and a dose-dependent response to vancomycin.”
DeBurlo and Gregory Ogawa, MD, performed a retrospective outcomes analysis of 172,635 cataract surgeries at one Eye Associates of New Mexico practice using a 14-year database to investigate the association between the use of 0.02 mg/mL of vancomycin in the infusate and development of hemorrhagic occlusive retinal vasculitis (HORV). Relevant diagnoses included retinal vascular abnormalities and neovascular glaucoma within 3 months of surgery, and a retina specialist evaluated flagged eyes.
The coding review returned 314 eyes, with three cases submitted to the specialist, but no cases of HORV were found.
Additionally, no corneal edema or significant increases in venous dilation or tortuosity were found. However, therapy with additional intravitreal vancomycin was associated with poorer outcomes.
“The good future question is to clarify the prevalence of endophthalmitis in our patient population and to clarify the benefit of using vancomycin in the infusion solution weighed against the risk of developing HORV, which seems to be relatively low,” DeBurlo said.
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DeBurlo R, et al. Examining HORV: Safety of vancomycin in the cataract infusion solution. Presented at: American Academy of Ophthalmology meeting; Sept. 30-Oct. 3, 2022; Chicago.
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