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# Compounding Drug HORV Alert
- URL: https://www.fdaweb.com/compounding-drug-horv-alert/
- Published: 2017-10-04T12:00:00.000Z
- Updated: 2026-09-14T22:54:02.000Z
- Author: David McFarland
- Tags: Drugs, #legacy-id-D5139787

FDA says hemorrhagic occlusive retinal vasculitis (HORV) has been observed in dozens of patients who have receive intraocular injections of vancomycin formulations toward the end of otherwise uncomplicated cataract surgeries. A [Compounding Drug Alert](https://www.fda.gov/Drugs/GuidanceComplianceRegulatoryInformation/PharmacyCompounding/ucm578514.htm?ref=fdaweb.com) discusses an adverse event report received 8/14 from a doctor about a patient who was diagnosed postoperatively with bilateral HORV after being administered injections of a compounded triamcinolone, maxifloxacin, and vancomycin (TMV) in each eye at the conclusion of cataract surgery procedures performed two weeks apart. The TMV formulation was compounded by Imprimis Pharmaceuticals, Ledgewood, NJ.

The alert says the agency is unaware of any adequately controlled studies demonstrating the safety and efficacy of intraocular vancomycin in preventing endopthalmitis, and there is no FDA-approved vancomycin formulation for intraocular injection.

According to FDA, the prophylactic use of intraocular vancomycin, alone or in a compounded drug combining multiple active ingredients, during cataract surgery is generally not recommended due to the risk of HORV.

The agency approved 9/28 a supplemental NDA to add a subsection about HORV to the Warnings section of the vancomycin label.