Eyeworld

EW NEWS & OPINION July 2016 19 an appropriate description of the current state of knowledge concern- ing HORV. "Regarding the question of delaying surgery on the second eye, there is 1 caveat," he said. "If significant aniseikonia exists follow- ing the first surgery, depth percep- tion will obviously be negatively affected." In such cases, the risk of accidents, falls, and other problems can be predicted to increase if great- er time is allotted between surgeries, he said. Based on current informa- tion, it is not possible to determine if this increased risk is greater than the presumed benefit that may occur if second eye surgery is delayed to evaluate the first eye for possible HORV, Dr. Mackool said. Dr. Mackool said that he will continue to administer vancomycin at the time of intraocular surgery. "The administration of a fourth generation fluoroquinolone has been demonstrated to reduce the incidence of endophthalmitis, but these drugs appear to do so with significantly less efficacy than vancomycin," he said. EW References 1. Nicholson LB, et al. Severe bilateral ischemic retinal vasculitis following cataract surgery. Ophthalmic Surg Lasers Imaging Retina. 2014;45:338–342. 2. Witkin AJ, et al. Postoperative hemorrhagic occlusive retinal vasculitis: Expanding the clin- ical spectrum and possible association with vancomycin. Ophthalmology. 2015;122:1438– 1451. 3. Endophthalmitis Study Group, European Society of Cataract & Refractive Surgeons. Prophylaxis of postoperative endophthalmitis following cataract surgery: results of the ESCRS multicenter study and identification of risk factors. J Cataract Refract Surg. 2007;33:978–88. 4. Wykoff CC, et al. Allergy to povidone-iodine and cephalosporins: the clinical dilem- ma in ophthalmic use. Am J Ophthalmol. 2011;151:4–6. Editors' note: The physicians have no financial interests related to their comments. Contact information Liegner: liegner@eyecarenw.com Mackool: mackooleye@aol.com Shorstein: nshorstein@eyeonsight.org Stiverson: richard.stiverson@kp.org Dr. Liegner also pointed out that it's not known yet whether this is really a type III hypersensitivity to vancomycin or perhaps a com- pounding or mixing issue. He said perhaps the patients who developed HORV after intracameral vanco- mycin could be asked to receive an intradermal vancomycin injection to confirm if it was in fact a type III hypersensitivity reaction to the antibiotic. "Some lost their vision and they already sacrificed their eyes in the worst possible way. Asking them to show us if they have a skin reac- tion to a drug to implicate whether that's true or not is a small addi- tional risk," Dr. Liegner said. "This is a planetary issue, especially with MRSA reaching 80% thresholds in some communities." New Maskin ® * MGD Products 3360 Scherer Drive, Suite B, St. Petersburg, FL 33716 800-637-4346 • Tel: 727-209-2244 • Fax: 727-341-8123 Email: Info@RheinMedical.com • Website: www.RheinMedical.com *Developed In Coordination With Steven L. Maskin, M.D., European Patent No. 2,222,355 PCT/US08/083318, Intraductal Meibomian Gland Probing Relieves Symptoms Of Obstructive Meibomian Gland Dysfunction, Maskin, Steven L, Cornea. 29(10):1145-1152, October 2010. Mantegna, Madonna with Child & Cherubim BCBB 1325 Rev.A 76um Probes 110um Tubes 150um Dilators 150um Tubes Meibum Expressor Call 727-209-2244 For More Information. Testimonial Testimonial Richard Mackool, MD, Mackool Eye Institute, Astoria, New York Dr. Mackool uses intracameral van- comycin, and his experience using it has been extremely favorable. He finds that it dramatically reduces the incidence of endophthalmitis to the point of near elimination. At Dr. Mackool's ASC, he said there have been 80,000 consecutive cataract implant procedures done by 40 surgeons without a single case of endophthalmitis or HORV. Vanco- mycin virtually eliminates the risk of endophthalmitis, Dr. Mackool said. Whatever the cause of HORV, its incidence is extraordinarily small. "It is not possible to know that incidence, but based upon our expe- rience and unpublished reports from a number of other ASCs, it appears to be 1 in 250,000 eyes or less," he said. "The extreme rarity of HORV and the effectiveness of vancomy- cin in preventing endophthalmitis would appear to indicate that the risk/benefit ratio of intracameral vancomycin remains favorable." Dr. Mackool thinks that the ASCRS/ASRS Clinical Alert represents

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