June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
Injection Drug Use-Associated Endogenous Endophthalmitis Compared to Endogenous Endophthalmitis From Other Etiologies
Author Affiliations & Notes
  • Jeffrey C Powell
    Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, United States
  • Eliza Barnwell
    Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, United States
    Wills Eye Hospital, Philadelphia, Pennsylvania, United States
  • Jason A Zehden
    The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
  • Pali Singh
    Duke University, Durham, North Carolina, United States
  • Ciociola C Liz
    The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
  • Alice Zhang
    The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
  • Sharon Fekrat
    Duke University, Durham, North Carolina, United States
  • Margaret A Greven
    Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, United States
  • Footnotes
    Commercial Relationships   Jeffrey Powell None; Eliza Barnwell None; Jason Zehden None; Pali Singh None; Ciociola Liz None; Alice Zhang None; Sharon Fekrat None; Margaret Greven None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 3931. doi:
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      Jeffrey C Powell, Eliza Barnwell, Jason A Zehden, Pali Singh, Ciociola C Liz, Alice Zhang, Sharon Fekrat, Margaret A Greven; Injection Drug Use-Associated Endogenous Endophthalmitis Compared to Endogenous Endophthalmitis From Other Etiologies. Invest. Ophthalmol. Vis. Sci. 2023;64(8):3931.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Despite the increasing rate of injection drug use (IDU)-associated endogenous endophthalmitis, there is limited data to evaluate associated characteristics, microbiology, and clinical outcomes. We performed a retrospective, observational clinical study to compare features of IDU-associated endogenous endophthalmitis to endogenous endophthalmitis from other etiologies.

Methods : Retrospective review was performed of all cases of endogenous endophthalmitis treated at three academic institutions over an average of 6.3 years, ranging from February 2012 to January 2021. Baseline characteristics including visual acuity (VA), sex, age, etiology of endogenous endophthalmitis, and systemic comorbidities were recorded. Vitreous and blood culture data, treatment details, and final VA were recorded. Patients were grouped based on IDU status. Statistical analysis was conducted to compare presenting characteristics, diagnostic culture results, and VA outcomes between groups.

Results : Thirty-eight (33.6%) patients had IDU-associated endogenous endophthalmitis (IDU group), while 75 (66.4%) had endogenous endophthalmitis from other causes (non-IDU group). Compared to patients in the non-IDU group, patients in the IDU group were significantly younger (36.3 v 58.4 years, p<0.0001), more frequently male (68.4% v. 46.7% male, p=0.045), had longer duration of symptoms at diagnosis (21.2 v. 10 days, p=0.0009), and less likely to have bilateral disease (5.3% v. 24%, p=0.0174). They were less likely to be admitted to the hospital (71.1% vs 92.0%, p=0.0052) and less likely to receive treatment with intravenous antibiotics (55.3% vs 82.7%, p=0.0031). Patients in the IDU group were less likely to have an identifiable source of systemic infection (28.9% vs 70.7%, p<0.001) or positive cultures (37.4% vs 78.7%, p=0.0080). Mean presenting VA, change in VA, and final VA were not significantly different between the two groups.

Conclusions : Compared to other etiologies, IDU-associated endogenous endophthalmitis presents in younger patients with fewer comorbidities and frequently without concomitant systemic infection or positive culture results. Therefore, a high index of suspicion is needed by clinicians to identify IDU-associated endogenous endophthalmitis, especially in those without bilateral disease . In both groups, despite treatment, there was comparable marked ocular morbidity.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

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