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Preston Mackenzie Luong, Edmund Tsui, Nikhil Batra, Michael E Zegans; Trends of intravenous drug use associated endogenous endophthalmitis at a tertiary care center. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5504.
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© ARVO (1962-2015); The Authors (2016-present)
The New Hampshire Drug Monitoring Initiative estimates 488 statewide drug overdose deaths for the 2016 year, a 199% increase since 2012. The New England opioid epidemic poses a major risk factor for an increase in incidence of endogenous endophthalmitis, but it is unknown whether an actual increase in cases has occurred. We aim to investigate the trends of intravenous drug use (IVDU) associated endogenous endophthalmitis at the Dartmouth-Hitchcock Medical Center (DHMC) over the past five years and identify key historical and clinical features of these cases.
13 cases of endogenous endophthalmitis from all causes were identified in the five year period from 2012-2016 within the DHMC electronic health record from searching the text string "endogenous endophthalmitis" and ICD-9 code "360.00". Cases were manually reviewed for the following specific factors: patient IVDU, microorganism identified if available, time from symptom onset to clinical presentation, visual acuity, clinical course, and evidence of prior systemic disease from non-IVDU causes. Statistical analysis was performed using the two-tailed student t-test.
Of the 13 cases of endogenous endophthalmitis, nine (69.2%) were IVDU associated. Four of these were observed in 2016, the year with the highest number of IVDU cases at DHMC. Candida albicans and coagulase-negative staphylococci were the most represented agents as identified through vitreous cultures although in six patients no causative organism was discovered. Compared with non-IVDU cases, IVDU cases involved younger patients (age 31.0±7.0 vs 62.0±15.8, p<.01) with a more delayed time from onset of symptoms to presentation (16.7±13.2 vs 1.0±1.4 days, p<.05). Five of the nine (56%) IVDU patients regained better than 20/200 vision while one of the four (25%) non-IVDU patients did so. During the course of the study, we also found IVDU patients with vision loss from non-endogenous endophthalmitis complications that included posterior uveitis and septic emboli leading to ischemia of the optic nerve and retina.
The increasing trend of IVDU-associated endogenous endophthalmitis cases in 2016 at DHMC may reflect the recent rise in opioid use in New England. Clinicians should recognize that the historical and clinical presentation of IVDU-associated endogenous endophthalmitis is distinct from that of non-IVDU causes.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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