EyeWorld India June 2017 Issue

June 2017 38 EWAP SECONDARY FEATURE 2017 EyeWorld Surgical Summit in Park City, Utah, noted several unanswered questions regarding vancomycin-associated HORV. • Do some people clear vancomycin (and other drugs) at different rates from the eye, leading to drug toxicity? • Are there other factors that could be preventing drug clearance in a minority of patients (e.g., postop IOP spike, hypotony, retained viscoelastic)? • Are there milder forms of disease that are going unnoticed, since most patients aren’t dilated until later in the postop course? Dr. Witkin pointed out that as of the moment, clinicians don’t definitively know whether vancomycin is actually the cause of the disease. At this point, there is also not a test to determine who may and who may not be at risk for this type of reaction. There is no skin test to predict or confirm a Type III hypersensitivity in known HORV patients, Dr. Chang said. “Clearly [vancomycin] is a useful agent. It’s been used by so many people for so many years, and it kills important bugs,” Dr. Miller said. “It would certainly be nice if we could select individuals who are going to have a problem and not treat them with it, but have it available to treat other patients. But we don’t have any way of doing that currently. There is probably going to be some genetic susceptibility. If we can identify those genetic factors, that could be an area of future research.” Going forward, Dr. Chang reminded his colleagues of the permanent online registry accessible through the ASCRS and ASRS websites at www.ascrs.org and www.asrs.org. “We urge ophthalmologists to report suspected cases so that we can continue to learn about the frequency and characteristics of this sobering complication,” he said. EWAP References 1. Witkin AJ, et al. Vancomycin- associated hemorrhagic occlusive retinal vasculitis. Ophthalmology . 2016. Article in Press. 2. Nicholson LB, Kim BT, Jardon J, Townsend-Pico W, Santos C, Moshfeghi AA, et al. Severe bilateral ischemic retinal vasculitis following cataract surgery. Ophthalmic Surg Lasers Imaging Retina . 2014;45(4):338–42. 3. Witkin AJ, Shah AR, Engstrom RE, Kron-Gray MM, Baumal CR, Johnson MW, et al. Postoperative hemorrhagic occlusive retinal vasculitis: Expanding the clinical spectrum and possible association with vancomycin. Ophthalmology . 2015;122(7):1438–51. 4. Heijnen EB, et al. Purpura in a patient receiving vancomycin: a leukoclastic vasculitis? J Cardiothorac Vasc Anesth . 2011;25:390–1. 5. Pongruangporn M, et al. Vancomycin- associated leukocytoclastic vasculitis. Case Rep Infect Dis . 2011:356370. 6. Davey PL, et al. Antibiotic hyper- sensitivity reactions and approaches to desensitization. Clin Infect Dis . 2013;58:1140–8. 7. Endophthalmitis Study Group European Society of Cataract and Refractive Surgery, Refractive S. Prophylaxis of postoperative endophthalmitis following cataract surgery: results of the ESCRS multicenter study and identification of risk factors. J Cataract Refract Surg . 2007;33:978–8. 8. Chang DF, et al. Antibiotic prophylaxis of postoperative endophthalmitis after cataract surgery: results of the 2014 ASCRS member survey. J Cataract Refract Surg . 2015;41:1300–5. 9. Rhee, DJ, et al. Report for antibiotic eyedrop regimen for cataract surgical patients survey. 2016. ASCRS Clinical Committee Report . 2016. Editors’ note: The physicians interviewed for this article have no financial interests related to their comments. Contact information Chang: dceye@earthlink.net Mamalis: nick.mamalis@hsc.utah.edu Miller: kmiller@ucla.edu Witkin: AWitkin@tuftsmedicalcenter.org Vancomycin – from page 37