Aubrey R Tirpack1, Jay S Duker1, Caroline R Baumal1. 1. New England Eye Center, Department of Vitreoretinal Surgery, Tufts University School of Medicine, Boston, Massachusetts.
Abstract
Importance: Intravenous drug abuse (IVDA) is a known risk factor for endogenous fungal endophthalmitis (EFE), a severe intraocular infection caused by hematogenous seeding of mycotic organisms to the eye. Reporting significant increases in heroin-related deaths since 2014, the New England region is in the midst of an opioid crisis that has led to a substantial increase in patients at risk for this vision-threatening disease. Objective: To present an update on characteristics, management, and visual outcomes in patients with EFE. Design, Setting, and Participants: Medical records review was initiated on July 1, 2016, evaluating all patients with EFE referred to New England Eye Center at Tufts Medical Center, a tertiary care ophthalmology practice distributed throughout Massachusetts, from May 1, 2014, to May 1, 2016. Patients with a history of IVDA and culture-proven or clinical evidence of fungal endophthalmitis were included. Exposures: Intravenous drug use. Main Outcomes and Measures: Patient demographics, comorbidities, presenting symptoms and vision, vitreoretinal findings, treatment regimens, culture data, and final visual acuities. Results: Ten patients (5 women) with IVDA-related EFE were identified between May 1, 2014, and May 1, 2016-an increase from 3 patients treated from May 2012 to April 2014. The mean (SD) patient age was 34 (11) years (range, 24-60 years). Presenting visual acuities ranged from 20/25 to hand motion. The most common presenting symptoms were floaters (n = 8), reduced vision (n = 6), and pain (n = 5). Initial treatment included systemic antifungals in all patients and intravitreal antifungals in 9 eyes. Five patients required pars plana vitrectomy for worsening vitritis. The most commonly isolated pathogen was Candida albicans in 20% of the patients. Final visual acuity ranged from 20/40 to 20/300. Conclusions and Relevance: The data provided in this report suggest that EFE represents severe end organ damage associated with IVDA and portends poor visual outcomes. Health care professionals must maintain a high suspicion for EFE, as patients are typically ambulatory on presentation without systemic signs of infection.
Importance: Intravenous drug abuse (IVDA) is a known risk factor for endogenous fungal endophthalmitis (EFE), a severe intraocular infection caused by hematogenous seeding of mycotic organisms to the eye. Reporting significant increases in heroin-related deaths since 2014, the New England region is in the midst of an opioid crisis that has led to a substantial increase in patients at risk for this vision-threatening disease. Objective: To present an update on characteristics, management, and visual outcomes in patients with EFE. Design, Setting, and Participants: Medical records review was initiated on July 1, 2016, evaluating all patients with EFE referred to New England Eye Center at Tufts Medical Center, a tertiary care ophthalmology practice distributed throughout Massachusetts, from May 1, 2014, to May 1, 2016. Patients with a history of IVDA and culture-proven or clinical evidence of fungal endophthalmitis were included. Exposures: Intravenous drug use. Main Outcomes and Measures: Patient demographics, comorbidities, presenting symptoms and vision, vitreoretinal findings, treatment regimens, culture data, and final visual acuities. Results: Ten patients (5 women) with IVDA-related EFE were identified between May 1, 2014, and May 1, 2016-an increase from 3 patients treated from May 2012 to April 2014. The mean (SD) patient age was 34 (11) years (range, 24-60 years). Presenting visual acuities ranged from 20/25 to hand motion. The most common presenting symptoms were floaters (n = 8), reduced vision (n = 6), and pain (n = 5). Initial treatment included systemic antifungals in all patients and intravitreal antifungals in 9 eyes. Five patients required pars plana vitrectomy for worsening vitritis. The most commonly isolated pathogen was Candida albicans in 20% of the patients. Final visual acuity ranged from 20/40 to 20/300. Conclusions and Relevance: The data provided in this report suggest that EFE represents severe end organ damage associated with IVDA and portends poor visual outcomes. Health care professionals must maintain a high suspicion for EFE, as patients are typically ambulatory on presentation without systemic signs of infection.
Authors: Nirzari Parikh; Michael R Nonnemacher; Vanessa Pirrone; Timothy Block; Anand Mehta; Brian Wigdahl Journal: Curr HIV Res Date: 2012-10 Impact factor: 1.581
Authors: Ahila Lingappan; Charles C Wykoff; Thomas A Albini; Darlene Miller; Avinash Pathengay; Janet L Davis; Harry W Flynn Journal: Am J Ophthalmol Date: 2011-09-13 Impact factor: 5.258
Authors: C Martínez-Vázquez; J Fernández-Ulloa; J Bordón; B Sopeña; J de la Fuente; A Ocampo; M Rubianes Journal: Clin Infect Dis Date: 1998-11 Impact factor: 9.079
Authors: Loka Thangamathesvaran; Joseph K Canner; Adrienne W Scott; Fasika A Woreta; Mark P Breazzano Journal: Eye (Lond) Date: 2022-04-29 Impact factor: 3.775
Authors: Kathleen A Regan; Nila S Radhakrishnan; Jon D Hammer; Benjamin D Wilson; Lara Beth Gadkowski; Siva S R Iyer Journal: BMC Ophthalmol Date: 2020-04-07 Impact factor: 2.209