title: Endogenous endophthalmitis associated with intravenous drug abuse: seven-year experience at a tertiary referral center.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Centre for Eye Research Australia, University of Melbourne, East Melbourne, Australia. drpaulconnell@gmail.com
authors.forename: Paul P
authors.initials: PP
authors.lastname: Connell
authors.forename: Evelyn C
authors.initials: EC
authors.lastname: O'Neill
authors.forename: F M
authors.initials: FM
authors.lastname: Amirul Islam
authors.forename: Robert
authors.initials: R
authors.lastname: Buttery
authors.forename: Mark
authors.initials: M
authors.lastname: McCombe
authors.forename: Rohan H
authors.initials: RH
authors.lastname: Essex
authors.forename: Edward
authors.initials: E
authors.lastname: Roufail
authors.forename: Stephen
authors.initials: S
authors.lastname: Lash
authors.forename: Bernard
authors.initials: B
authors.lastname: Wolffe
authors.forename: Ben
authors.initials: B
authors.lastname: Clark
authors.forename: Daniel
authors.initials: D
authors.lastname: Chiu
authors.forename: William
authors.initials: W
authors.lastname: Campbell
authors.forename: Penelope
authors.initials: P
authors.lastname: Allen
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D002175:Candida / Q000302:isolation & purification; D058365:Candidiasis, Invasive / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D002442:Ceftazidime / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D009877:Endophthalmitis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D015821:Eye Infections, Fungal / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D016469:Fungemia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012017:Referral and Consultation; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000150:complications*; D014640:Vancomycin / Q000627:therapeutic use; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D014640:Vancomycin; D002442:Ceftazidime