LAUSR

Atypical Bilateral Hemorrhagic Occlusive Retinal Vasculitis Associated With Intraocular Vancomycin: Severe Vascular Obstruction and Delayed Onset of Retinal Hemorrhage A 62-year-old female patient, who underwent bilateral same-day cataract surgery with intracameral vancomycin injection 5 days ago and normal fundus finding at postoperative 1 day, presented with sudden decrease in visual acuity in both eyes. Fundus examination revealed a relatively pale retina with extensive severe perivascular sheathing (Figure 1, A and B). Minimal amount of retinal hemorrhage was found in the peripheral retina (Figure 1, A and B, arrows). Fluorescein angiography demonstrated marked perivascular leakage and severe vascular obstruction in both eyes (Figure 1, C and D). Spectral domain optical coherence tomography showed increased reflectivity and thickening of the inner retina, indicating inner retinal ischemia (Figure 1, E and F). Under a provisional diagnosis of an atypical form of vancomycinassociated hemorrhagic occlusive retinal vasculitis (HORV), she was treated with high-dose intravenous methylprednisolone, followed by oral steroid therapy, which was tapered over a month. One month after the treatment, perivascular sheathing improved, but retinal hemorrhage increased markedly compared with the initial state (Figure 2, A and B). Although vasculitis improved, severe vascular nonperfusion remained on fluorescein angiography (Figure 2, C and D). Compared with retinal circulation, choroidal circulation was relatively intact on indocyanine green angiography (Figure 2, E and F).