Physical Incompatibility between Vancomycin and Viscoelastic Mimicking Acute Endophthalmitis: The First Report

This is the first documentation of vancomycin precipitation with viscoelastic in the anterior chamber of the eye. A 34-year-old white male underwent uneventful penetrating keratoplasty. Intracameral instillation of 1 mg/0.1 mL of vancomycin followed no attempts of meticulous viscoelastic irrigation....

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Main Authors: Biljana Kuzmanović Elabjer, Dean Šarić, Mladen Bušić, Mirjana Bjeloš, Andrej Pleše
Format: Article
Language:English
Published: Wiley 2019-01-01
Series:Case Reports in Ophthalmological Medicine
Online Access:http://dx.doi.org/10.1155/2019/6341694
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author Biljana Kuzmanović Elabjer
Dean Šarić
Mladen Bušić
Mirjana Bjeloš
Andrej Pleše
author_facet Biljana Kuzmanović Elabjer
Dean Šarić
Mladen Bušić
Mirjana Bjeloš
Andrej Pleše
author_sort Biljana Kuzmanović Elabjer
collection DOAJ
description This is the first documentation of vancomycin precipitation with viscoelastic in the anterior chamber of the eye. A 34-year-old white male underwent uneventful penetrating keratoplasty. Intracameral instillation of 1 mg/0.1 mL of vancomycin followed no attempts of meticulous viscoelastic irrigation. Six hours later thick white material in the anterior chamber was sedimented. The following criteria excluded the diagnosis of endophthalmitis and TASS: clear and transparent anterior chamber and vitreous body, the absence of ciliary injection and corneal oedema, and unremarkable laboratory tests’ results. This iatrogenic complication mimicking endophthalmitis does not require any specific management and should be acknowledged in guidelines for prevention and treatment of endophthalmitis. The objective of this paper is to alert colleagues to this iatrogenic complication of vancomycin mimicking endophthalmitis. Whether this condition should be labelled as positive or negative demands further investigation. As vancomycin is a time-dependent antibiotic, it is possible that this precipitate could serve as a slowly releasing drug depot and viscoelastic as a vehicle for precipitation. This being the case, investigation is needed to analyse its potential to precipitate with another dispersive and cohesive viscoelasticity.
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series Case Reports in Ophthalmological Medicine
spelling doaj-art-c999f4e2a1a34035a3b336bb817754272025-08-20T03:24:03ZengWileyCase Reports in Ophthalmological Medicine2090-67222090-67302019-01-01201910.1155/2019/63416946341694Physical Incompatibility between Vancomycin and Viscoelastic Mimicking Acute Endophthalmitis: The First ReportBiljana Kuzmanović Elabjer0Dean Šarić1Mladen Bušić2Mirjana Bjeloš3Andrej Pleše4University Eye Clinic, Faculty of Dental Medicine and Health Care Osijek, Faculty of Medicine Osijek, University Josip Juraj Strossmayer in Osijek, University Hospital “Sveti Duh”, Zagreb, CroatiaUniversity Eye Clinic, Faculty of Dental Medicine and Health Care Osijek, Faculty of Medicine Osijek, University Josip Juraj Strossmayer in Osijek, University Hospital “Sveti Duh”, Zagreb, CroatiaUniversity Eye Clinic, Faculty of Dental Medicine and Health Care Osijek, Faculty of Medicine Osijek, University Josip Juraj Strossmayer in Osijek, University Hospital “Sveti Duh”, Zagreb, CroatiaUniversity Eye Clinic, Faculty of Dental Medicine and Health Care Osijek, Faculty of Medicine Osijek, University Josip Juraj Strossmayer in Osijek, University Hospital “Sveti Duh”, Zagreb, CroatiaUniversity Eye Clinic, Faculty of Dental Medicine and Health Care Osijek, Faculty of Medicine Osijek, University Josip Juraj Strossmayer in Osijek, University Hospital “Sveti Duh”, Zagreb, CroatiaThis is the first documentation of vancomycin precipitation with viscoelastic in the anterior chamber of the eye. A 34-year-old white male underwent uneventful penetrating keratoplasty. Intracameral instillation of 1 mg/0.1 mL of vancomycin followed no attempts of meticulous viscoelastic irrigation. Six hours later thick white material in the anterior chamber was sedimented. The following criteria excluded the diagnosis of endophthalmitis and TASS: clear and transparent anterior chamber and vitreous body, the absence of ciliary injection and corneal oedema, and unremarkable laboratory tests’ results. This iatrogenic complication mimicking endophthalmitis does not require any specific management and should be acknowledged in guidelines for prevention and treatment of endophthalmitis. The objective of this paper is to alert colleagues to this iatrogenic complication of vancomycin mimicking endophthalmitis. Whether this condition should be labelled as positive or negative demands further investigation. As vancomycin is a time-dependent antibiotic, it is possible that this precipitate could serve as a slowly releasing drug depot and viscoelastic as a vehicle for precipitation. This being the case, investigation is needed to analyse its potential to precipitate with another dispersive and cohesive viscoelasticity.http://dx.doi.org/10.1155/2019/6341694
spellingShingle Biljana Kuzmanović Elabjer
Dean Šarić
Mladen Bušić
Mirjana Bjeloš
Andrej Pleše
Physical Incompatibility between Vancomycin and Viscoelastic Mimicking Acute Endophthalmitis: The First Report
Case Reports in Ophthalmological Medicine
title Physical Incompatibility between Vancomycin and Viscoelastic Mimicking Acute Endophthalmitis: The First Report
title_full Physical Incompatibility between Vancomycin and Viscoelastic Mimicking Acute Endophthalmitis: The First Report
title_fullStr Physical Incompatibility between Vancomycin and Viscoelastic Mimicking Acute Endophthalmitis: The First Report
title_full_unstemmed Physical Incompatibility between Vancomycin and Viscoelastic Mimicking Acute Endophthalmitis: The First Report
title_short Physical Incompatibility between Vancomycin and Viscoelastic Mimicking Acute Endophthalmitis: The First Report
title_sort physical incompatibility between vancomycin and viscoelastic mimicking acute endophthalmitis the first report
url http://dx.doi.org/10.1155/2019/6341694
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