Cefuroxime-related hemorrhagic retinal vasculitis following cataract surgery.

BACKGROUND: Intracameral cefuroxime is commonly used during cataract surgery to prevent postoperative endophthalmitis (POE). However, its association with rare complications, such as hemorrhagic occlusive retinal vasculitis (HORV), remains underreported. Reporting these cases is important to increase awareness of this rare but serious complication of intracameral cefuroxime in complicated cataract surgeries and to improve the understanding of its clinical presentation and potential risk factors. METHOD: We retrospectively reviewed cataract surgeries performed at a tertiary center between 2015 and 2023. Records of patients with posterior capsule rupture (PCR), vitreous complications, or postoperative visual loss referred to the retina unit were analyzed. Hemorrhagic retinal vasculitis (HRV) was diagnosed based on clinical findings and fundus fluorescein angiography (FFA), and comprehensive ocular and systemic evaluations were performed to exclude other etiologies. RESULTS: During the study period, PCR occurred in 278 eyes, and intracameral cefuroxime prophylaxis at the standard dose (1 mg/0.1 mL) was administered in 245 of these eyes. Among the eyes treated with cefuroxime, three cases of HRV were identified. All presented with impaired vision in the early postoperative period. Fundus examination revealed diffuse retinal vascular occlusion, hemorrhages clustered along venules, and macular whitening, while FFA demonstrated hypofluorescent areas, widespread peripheral vascular occlusion, and ischemia. All patients underwent panretinal photocoagulation (PRP). One patient subsequently developed ocular neovascularization, rhegmatogenous retinal detachment, and phthisis bulbi; in the remaining two, no neovascularization was observed, although one developed optic atrophy. CONCLUSIONS: HRV may occur following intracameral cefuroxime at recommended doses in complicated cataract surgery with posterior capsule compromise. Surgeons should be aware of this rare but serious complication, particularly when posterior capsule integrity is compromised and the administered dose may reach the vitreous.