April 20, 2018 Conference
To review the presentation, pathophysiology, diagnosis, and management of endogenous endophthalmitis in the setting of our regional and national opiod crisis with increased rates of IV drug use.
Purpose: From 2000 to 2014, the United States experienced a tripling in number of opioid overdose deaths. As of 2015, New Hampshire has one of the highest age-adjusted rates of death due to drug overdose at 34.3 per 100,000 persons. We investigated clinical characteristics of injection drug use (IDU) versus non-IDU endogenous endophthalmitis (EE) at Dartmouth-Hitchcock Medical Center (DHMC) during the opioid epidemic.
Methods: A retrospective chart review identified EE cases from January 2012 to December 2016 at DHMC via International Classification of Diseases (ICD-9, ICD-10) codes 360.0*, 360.1*, H44.0*, and H44.1*. Patient demographics, IDU history, microbial data, and clinical courses were recorded and analyzed.
Results: Fifteen patients with EE were identified, of which 9/15 (56.3%) had a history of IDU. Reduced vision was the most common presenting symptom in all IDU (9/9) and most non-IDU (5/6) patients. Compared with non-IDU patients, IDU patients were younger (31 vs 63 years, P<0.001) and had fewer co-morbidities. There was a trend for IDU patients to delay seeking care compared with non-IDU patients (24.7 vs 2.0 days). IDU patients demonstrated significantly more improvement in visual acuity after intervention than non-IDU patients. Non-IDU cases were more likely to present during hospitalization or shortly after discharge and less likely to undergo surgical intervention because of more frequent resolution of vitritis.
Conclusions: Patients with IDU-related EE were younger, ambulatory, and presented later than non-IDU related EE patients. Importantly, IDUrelated EE patients were more likely to experience improved vision with treatment than non-IDU related EE patients. IDU patients represent a younger and healthier subset of the EE population and may regain vision upon prompt recognition and treatment.
1. Tirpack AR, Duker JS, Baumal CR. An Outbreak of Endogenous Fungal Endophthalmitis Among Intravenous Drug Abusers in New England. JAMA Ophthalmol. 2017 Jun 1;135(6):534-540. 2. Bobeck S. Modjtahedi, MD, Avni V. Finn, MD, Thanos D. Papakostas, MD, Marlene Durand, MD, Deeba Husain, MD, Dean Eliott. Intravenous Drug Use–Associated Endophthalmitis. Ophthalmol Retina. 3. Patel SN, Rescigno RJ, Zarbin MA, Langer P, Bhagat N. Endogenous endophthalmitis associated with intravenous drug abuse. Retina. 2014;34(7):1460e1465.