Abstract
Purpose :
Endogenous endophthalmitis (EE) is a severe, vision-threatening ocular infection and represents 2-8% of all cases of endophthalmitis. Here we characterize the demographics, clinical progression, and outcomes of endogenous Candida endophthalmitis among patients with IVDU.
Methods :
We molecularly characterized 24 yeast isolates collected from patients diagnosed with endophthalmitis or keratitis at Massachusetts Eye and Ear from 2014-2022 using Multilocus Sequence Typing. A retrospective chart review was performed for all 24 cases of Candida EE.
Results :
Overall, 24 patients (19 male, 5 female) with age range of 10 months to 79 (average age 39) were diagnosed with EE. Nineteen patients (79%) had history of IVDU. Of these, cultures positive for C. albicans comprised of 13 eyes (68%) vs non-albicans group (n = 6, 32%). Other risk factors included Hepatitis C virus infection (n = 15, 63%) and history of incarceration (n = 13, 54%). Burden of significant systemic comorbidies such as cancer, uncontrolled diabetes, and sepsis occurred in patients at extremes of age, and all were from the C. albicans group.
Visual acuity on presentation was on average 20/275 (1.14 logMAR) with range from 20/60 (0.48 logMAR) to LP (3 logMAR). Final visual acuity on average was 20/50 (0.42 logMAR). Visual acuity improvement occurred in 16 eyes (64%). The presenting visual acuity for non-albicans group was worse (1.4 logMAR) vs C. albicans group (1.07 logMAR), but percentage of patients with visual acuity improvement was similar at 62% for C. albicans group vs 67% for non-albicans group.
Treatments and workup included intravitreal tap and inject of antibiotics and/or antifungals, anterior chamber taps, and systemic antifungals. Pars plana vitrectomy (PPV) was performed in 23 eyes, 5 of which required a second PPV due to retinal detachments, vitreous hemorrhage, or ERM. More patients from the C. albicans group required a secondary PPV (n = 3, 23%) and more suffered from secondary sequelae (n = 7, 54%) vs. non-albicans group (n = 1, 17% and n = 2, 33%).
Conclusions :
Our study shows the patient characteristics, clinical progression, and ocular consequences of EE in patients with IVDU. Differences in outcomes among patients with culture positive for C. albicans vs. non-C. albicans group indicate further need to better understand the microbial etiology of EE to improve treatment of population at risk.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.