History of Present Illness
A 70-year-old man with a history of hypertension, hyperlipidemia, and emphysema presented to an optometrist with sudden loss of vision in the left eye (OS) 2 weeks after seemingly uncomplicated cataract surgery. Uncorrected visual acuity was 20/20 1 day after cataract surgery. The sudden loss of vision occurred over a 10-minute period while eating dinner. He presented to an optometrist, who suspected central retinal vein occlusion and then referred him to the retina clinic for further evaluation.
| OD | OS | |
|---|---|---|
| Visual acuity | 20/20 | Hand motion |
| Intraocular pressure (IOP) | 12 | 14 |
| Sclera/conjunctiva | White and quiet | White and quiet |
| Cornea | Clear | Clear |
| Anterior chamber (AC) | Deep and quiet | Deep and quiet |
| Iris | Unremarkable | Unremarkable |
| Lens | Well-positioned posterior chamber intraocular lens | Well-positioned posterior chamber intraocular lens |
| Anterior vitreous | Clear | Clear |
| Dilated Fundus Examination (DFE) | Normal | See Fig. 40.1A |
Questions to Ask
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Do you have eye pain?
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Did you receive intraocular antibiotics at the time of cataract surgery?
He reported no eye pain. Review of records showed he received intracameral vancomycin 1 mg/0.1 mL at the end of uncomplicated cataract surgery.
Assessment
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Postoperative hemorrhagic occlusive retinal vasculitis (HORV) OS
Differential Diagnosis
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Vancomycin-associated HORV
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Less likely: Postoperative infectious endophthalmitis; central retinal vein occlusion; syphilis-, tuberculosis-, or sarcoid-associated uveitis; antineutrophil cytoplasmic antibodies (ANCA)–associated vasculitis
Working Diagnosis
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Vancomycin-associated HORV
Testing
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Fluorescein angiography is necessary to confirm occlusive retinal vasculitis (see Fig. 40.1B ).
