ENDOGENOUS ENDOPHTHALMITIS ASSOCIATED WITH INTRAVENOUS DRUG ABUSE: Seven-Year Experience at a Tertiary Referral Center

Purpose: Intravenous drug use (IVDU) is a known risk factor for endogenous endophthalmitis. Endogenous fungal endophthalmitis (EFE) is emerging as a common problem among this community. We describe the management and visual outcomes of acute IVDU-associated EFE. Methods: A prospective consecutive case series of 19 patients presenting with presumed acute IVDU-associated EFE from 2001 to 2007 to the Royal Victorian Eye and Ear Hospital was included. All data were collected in a standardized manner. Outcome measures included visual acuity, microbial profiles, and vitrectomy rate. Results: Nineteen cases of IVDU-associated EFE were identified. Eight of these (42%) were men, and the mean age was 32.7 years (SD ± 8.0 years). Presenting visual acuity ranged from 6/6 to perception of light, with 58% having a visual acuity of 6/48 or less at presentation. Thirteen (68.4%) were culture positive with all cultures identifying Candida species, and 52.7% underwent vitrectomy. Fifty percent of subjects overall achieved a final visual acuity of 6/18 or better. Men demonstrated improved visual acuity when compared with women (P = 0.04). Age had no effect on final acuity. Conclusion: Intravenous drug use is a significant risk factor for developing EFE. Good visual outcomes can be achieved with early treatment, often with intravitreal therapy alone.

[1]  P. Sowmya,et al.  Diagnostic Utility of Polymerase Chain Reaction on Intraocular Specimens to Establish the Etiology of Infectious Endophthalmitis , 2009, European journal of ophthalmology.

[2]  L. Laroche,et al.  New test for the diagnosis of bacterial endophthalmitis , 2009, British Journal of Ophthalmology.

[3]  Gezhi Xu,et al.  Vitrectomy for Endogenous Fungal Endophthalmitis , 2009, Ocular immunology and inflammation.

[4]  L. Laroche,et al.  Rapid detection and quantification of Propionibacteriaceae , 2008, British Journal of Ophthalmology.

[5]  B. Tarai,et al.  FUNGAL ENDOPHTHALMITIS: Fourteen Years’ Experience From a Center in India , 2008, Retina.

[6]  P. Attal,et al.  Endophtalmie endogène à Candida secondaire à l’utilisation de la buprénorphine par voie intraveineuse , 2008 .

[7]  C. Vasseneix,et al.  [Endogenous Candida endophthalmitis in drug misusers injecting intravenous buprenorphine]. , 2008, Journal francais d'ophtalmologie.

[8]  V. Ahuja,et al.  Evaluation of outcome of various treatment methods for endogenous endophthalmitis. , 2006, Indian journal of medical sciences.

[9]  S. Hedderwick,et al.  Diagnosis and Treatment of Endogenous Fungal Endophthalmitis , 2006, Ophthalmologica.

[10]  H. Takebayashi,et al.  Relation between stage of endogenous fungal endophthalmitis and prognosis , 2006, Graefe's Archive for Clinical and Experimental Ophthalmology.

[11]  P. Allen,et al.  Fungal endophthalmitis in intravenous drug users injecting buprenorphine contaminated with oral Candida species , 2005, The Medical journal of Australia.

[12]  Y. Aso,et al.  Endogenous Endophthalmitis and Disseminated Intravascular Coagulation Complicating a Klebsiella pneumoniae Perirenal Abscess in a Patient with Type 2 Diabetes , 2005, The American journal of the medical sciences.

[13]  D. Talwar,et al.  First contact management of postoperative endophthalmitis. A retrospective analysis. , 2004, Indian journal of ophthalmology.

[14]  D. Goldsmith,et al.  Aspergillus endophthalmitis: an unusual complication of disseminated infection in renal transplant patients. , 2003, The Journal of infection.

[15]  N. Cassoux,et al.  Presumed ocular candidiasis in drug misusers after intravenous use of oral high dose buprenorphine (Subutex) , 2002, The British journal of ophthalmology.

[16]  J. C. Nichols,et al.  Endophthalmitis in patients with disseminated fungal disease. , 2002, Transactions of the American Ophthalmological Society.

[17]  Carpenter,et al.  Candida albicans endophthalmitis in brown heroin addicts: response to early vitrectomy preceded and followed by antifungal therapy. , 1998, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[18]  J. Bouchez,et al.  Substitution with Buprenorphine in Methadone- and Morphine Sulfate-Dependent Patients , 1998, European Addiction Research.

[19]  W. Smiddy.  Treatment outcomes of endogenous fungal endophthalmitis. , 1998, Current opinion in ophthalmology.

[20]  H. Flynn,et al.  Treatment outcomes in a 10-year study of endogenous fungal endophthalmitis. , 1997, Ophthalmic surgery and lasers.

[21]  W. Liles,et al.  Endogenous bacterial endophthalmitis. Report of a ten-year retrospective study. , 1994, Ophthalmology.

[22]  C. Leen,et al.  Fungal infections in drug users. , 1991, The Journal of antimicrobial chemotherapy.

[23]  J. Band,et al.  The clinical spectrum of endophthalmitis: incidence, predisposing factors, and features influencing outcome. , 1990, The Journal of infectious diseases.

[24]  B. Dupont,et al.  Cutaneous, ocular, and osteoarticular candidiasis in heroin addicts: new clinical and therapeutic aspects in 38 patients. , 1985, The Journal of infectious diseases.

[25]  C. Gallien,et al.  Epidemiological and clinical approach to the study of candidiasis caused by Candida albicans in heroin addicts in the Paris region: analysis of 35 observations. , 1982, Bulletin on narcotics.