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ENDOGENOUS ENDOPHTHALMITIS ASSOCIATED WITH INTRAVENOUS DRUG ABUSE: Seven-Year Experience at a Tertiary Referral Center

Connell, Paul P FRCSI (OPHTH)*†; O'neill, Evelyn C MRCOphth*†; Amirul Islam, F M PhD*; Buttery, Robert FRANZCO; McCombe, Mark FRANZCO; Essex, Rohan H FRANZCO; Roufail, Edward FRANZCO; Lash, Stephen FRCOphth; Wolffe, Bernard FCOphth SA; Clark, Ben FRANZCO; Chiu, Daniel FRANZCO; Campbell, William FRANZCO*; Allen, Penelope FRANZCO

doi: 10.1097/IAE.0b013e3181dd6db6
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Purpose: 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.

Conclusion: 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.

Intravenous drug use is a signifi cant risk factor for developing EFE. Good visual outcomes can be achieved with early treatment, often with intravitreal therapy alone.

From the *Centre for Eye Research Australia, University of Melbourne, East Melbourne, Australia; and †Vitreo-retinal Unit, The Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.

The authors have no conflicts of interest to disclose.

Reprint requests: Paul P. Connell, FRCSI(OPHTH), Vitreo-retinal Unit, The Royal Victorian Eye and Ear Hospital, 32 Gisborne St, East Melbourne, Victoria, Australia 3002; e-mail: drpaulconnell@gmail.com

© The Ophthalmic Communications Society, Inc.