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Shriji Patel, Ronald Rescigno, Marco Zarbin, Neelakshi Bhagat; Endogenous Endophthalmitis associated with intravenous drug abuse. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1115.
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To describe demographics, characteristics and management of eyes with endogenous endophthalmitis (EE) in intravenous (IV) drug abusers.
Retrospective chart review of patients with EE that presented to University Hospital (UH), New Jersey Medical School between January 2005 and October 2012.
34 patients presented with a clinical diagnosis of EE during this time period. 18 patients (53%) had a history of intravenous drug abuse (IVDA) with most cases consisting of IV heroin abuse. Two patients reported concomitant use of heroin with lemon juice. Average age was 43 years (24-61), 13 were males. Both eyes were involved in 3 of 18 patients (total of 21 eyes). Vision on presentation in the affected eye ranged from 20/100 to no light perception; the majority of patients presented with counting fingers vision or worse. All eyes presented with anterior uveitis and vitritis. Detailed examination of the retina could be performed only in 14 of the 21 eyes; 11 showed macular involvement. All patients were admitted to the hospital for IV antibiotics and/or antifungals as well as further workup, average length of stay was 12 days (4-28 days). 10 of the 18 patients received intravenous antifungals (3 Amphotericin, 7 Voriconazole) during their hospital course for suspected fungal etiology. Only patients with documented history of bacteremia, endocarditis or meningitis (8 of 18) did not receive antifungals. All 18 patients received IV antibiotics, most commonly Vancomycin and Ceftazidime. Certain patients were also on Zosyn, Nafcillin or Rifampin at the discretion of the Infectious Disease service. 16 eyes underwent a vitreous biopsy, four had positive cultures (2 Candida albicans, 2 coagulase negative Staph Aureus). 7 eyes underwent pars plana vitrectomy with intravitreal injections (occurring an average of 3.5 days after presentation). 2 eyes underwent an anterior chamber tap with one positive culture (Corynebacterium). Final BCVA at last followup ranged from 20/20- to NLP, with most patients having final vision of 20/400 or worse. Four eyes (19%) had vision better than 20/400. Two patients eventually underwent enucleation, one patient passed away from cardiac arrest while in the hospital.
We reviewed 21 eyes of 18 patients with EE and concurrent IVDA over an eight year period; ten patients with fungal EE. Our study shows an extremely poor visual prognosis associated with EE in this setting.
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