EyeWorld India September 2016 Issue

September 2016 EWAP FEATURE 17 rare. Without knowing how many patients have received intracameral vancomycin, however, the actual rate is unknown. Considerations for intraocular vancomycin use • Because HORV appears to be extremely rare, each surgeon should weigh the potential risk of HORV associated with vancomycin against the risk of endophthalmitis. • Reconsider using vancomycin with close sequential bilateral cataract surgery. • Surgeons using intraocular vancomycin with sequential cataract surgery should be aware that in addition to delayed onset, HORV may not cause symptoms in the first eye, and a dilated retinal examination may be the only way to detect it. • Surgeons desiring an alternative to vancomycin for intracameral prophylaxis may consider cefuroxime or moxifloxacin. 4 Recommendations for management of HORV • Consider avoiding intravitreal vancomycin if both bacterial endophthalmitis and HORV are in the differential. • Consider ocular and/or systemic work-up for other syndromes (e.g., viral retinitis). • Aggressive systemic and topical corticosteroids; consider peri- or intraocular steroids • Early anti-VEGF treatment • Early panretinal photocoagulation • If you identify a patient with HORV, please submit the clinical data to the HORV registry site (links from www.asrs.org and www.ascrs. org). Patient and surgeon names will be kept confidential. EWAP References 1. Nicholson LB, Kim BT, Jardon J, et al. Severe bilateral ischemic retinal vasculitis following cataract surgery. Ophthalmic Surg Lasers Imaging Retina . 2014;45:338–342. 2. Witkin AJ, Shah AR, Engstrom RE, Kron- Gray MM, et al. Postoperative hemorrhagic occlusive retinal vasculitis: Expanding the clinical spectrum and possible association with vancomycin. Ophthalmology . 2015;122:1438–1451. 3. Chang DF, Braga-Mele R, Henderson BA, Mamalis N, et al. Antibiotic prophylaxis of postoperative endophthalmitis after cataract surgery: Results of the 2014 ASCRS member survey. J Cataract Refract Surg . 2015;41:1300–1305. 4. Braga-Mele R, Chang DF, Henderson BA, Mamalis N, et al. Intracameral antibiotics: Safety, efficacy, and preparation. J Cataract Refract Surg. 2014;40:2134–2142. This ASCRS/ASRS alert is provided for informational and educational purposes only. It is not intended to mandate or establish a specific standard of care or dictate the treatment of any particular patients. ASCRS and ASRS members must make independent judgments about the treatment of their patients based on all the facts and circumstances relating to each patient’s condition. Contact information Chang : dceye@earthlink.net Witkin: ajwitkin@gmail.com