Post – Cataract Surgery Hemorrhagic Occlusive Retinal Vasculitis (Horv) – A Case Report

To present an interesting complication of intracameral antibiotics administration after a complicated cataract surgery.

A 67-year-old male underwent phacoemulsification operation in his left eye (LE) that was complicated by a minor posterior capsule tear without vitreous loss . There was no need for anterior vitrectomy, and an one-piece intraocular lens was placed in the bag. We administrated intracameral ceftriaxone in the anterior chamber as per usual protocol.

The first day after the surgery ,the ocular findings were normal . However,seven days later the patient presented with decreased vision in his (LE) .A thorough medical and ocular history was obtained and the patient underwent a complete ocular examination, including best corrected visual acuity (BCVA), intraocular pressure (IOP), pupillary reflexes, ocular mobility and slit lamp examination of the anterior and posterior segment .We then performed Optical Coherence Tomography (OCT), Fundus Autofluorescence (FAF), Fluorescein Angiography (FA) and Indocyanine Green Angiography (ICGA) .

Clinical examination and imaging of the right eye were normal. Visual acuity in the LE was 1/10.Anterior segment and IOP were normal. LE fundoscopy (Fd) revealed multiple diffuse intraretinal hemorrhages. OCT reported atrophy of the macula and absence of photoreceptor in inner and outer segment junction layer. FAF demonstrated numerous diffused hypoautofluorescent defects and FA showed many diffused hypofluorescent defects, consistent with hemorrhages observed during Fd. ICGA revealed hypofluorescent defects located on the lower arcade. Further laboratory tests,magnetic resonance imaging and cardiological examination were performed.Finally the patient was diagnosed with HORV associated to intracameral use of antibiotics.  

The patient was treated with aggressive topical corticosteroids, intraocular steroids and one anti-VEGF injection in order to prevent further vision loss and retinal neovascularization due to extensive retinal ischemia. This case demonstrates that although the proved necessity of intracameral antibiotics administration after phacoemulsification, all surgeons should be aware of the possible complications that these medications could cause and for their proper management.