Haemorrhagic occlusive retinal vasculitis caused by intravitreal vancomycin

Intraocular Vancomycin is used as a treatment as well as prophylaxis of endophthalmitis, but in rare instances it can cause serious ischaemic vasculitis. The most salient features of the disease include painless visual loss after cataract surgery, mild to moderate inflammation in the anterior chamber and peripheral retinal involvement with patchy haemorrhages and ischaemic vasculitis. We present case reports of two such patients who were identified with ischaemic vasculitis when they were given intravitreal Vancomycin for treatment of suspected endophthalmitis after complicated phacoemulsification surgery. Both developed profound visual loss with typical signs of haemorrhagic occlusive retinal vasculitis (HORV). 25 gauge 3 ports parsplana (25G 3 PPV) vitrectomy was performed on both the patients and dropped lenticular matter were removed from the vitreous cavity. Topical antibiotics and steroids were given. There was no significant visual improvement in both the cases which illustrates the toxic potential of intraocular use of Vancomycin.