Endogenous endophthalmitis associated with intravenous drug abuse: seven-year experience at a tertiary referral center.
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.
Connell
Paul P
PP
Centre for Eye Research Australia, University of Melbourne, East Melbourne, Australia. drpaulconnell@gmail.com
O'Neill
Evelyn C
EC
Amirul Islam
F M
FM
Buttery
Robert
R
McCombe
Mark
M
Essex
Rohan H
RH
Roufail
Edward
E
Lash
Stephen
S
Wolffe
Bernard
B
Clark
Ben
B
Chiu
Daniel
D
Campbell
William
W
Allen
Penelope
P
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
D000935:Antifungal Agents; D014640:Vancomycin; D002442:Ceftazidime