Retinal Neovascularization and Endogenous Fungal Endophthalmitis in Intravenous Drug Users

Doan, Thuy; Vemulakonda, Gurunadh Atmaram; Choi, Deana; Keene, C. Dirk; Akileswaran, Lakshmi; Gelder, Russell N. Van; Chao, Jennifer R.

doi:10.1016/j.ophtha.2014.03.037

Cited by 6 publications

(4 citation statements)

References 4 publications

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“…Prolonged or severe inflammation in the ocular structure will cause disturbance of the balance between local stimulators and inhibitors of microvasculature especially release of angiogenic factors, including v ascular endothelial growth factor by inflammatory cells mainly macrophages in chronic inflammation. [ 9 ] The NVG in our case occurred after successful treatment of ocular candidiasis with resolving inflammation. The fluorescein angiography of the patient showed patchy capillary fall-out areas with no leaky new vessels or vasculitis changes.…”

Section: Discussionmentioning

confidence: 85%

Chronic endogenous fungal endophthalmitis: diagnostic and treatment challenges

Talib

Yong²,

Nasaruddin³

et al. 2021

Medicine

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Rationale: Endogenous fungal endophthalmitis (EFE) is a sight-threatening complication of systemic fungemia. As the prevalence rises, treatment remains a challenge especially when there is a failure in first-line treatment or drug-resistant fungus. This case report studies a case of chronic EFE, focusing on the diagnostic procedures, treatment options, monitoring parameters and the treatment outcome Patient concerns: A 64-year-old man with underlying well controlled diabetes mellitus was treated with 2 weeks’ course of intravenous antifungal fluconazole for pyelonephritis as his blood culture grew Candida albicans . Concurrently, he complained of 3 months of bilateral painless progressive blurring of vision. At presentation, his visual acuity (VA) was light perception both eyes. Ocular examination revealed non granulomatous inflammation with dense vitritis of both eyes. Diagnosis: He was diagnosed with EFE but the condition responded poorly with the medications. Interventions: He was treated with intravitreal (IVT) amphotericin B and fluconazole was continued. Vitrectomy was performed and intraoperative findings included bilateral fungal balls in the vitreous and retina with foveal traction in the left eye. Postoperatively, vision acuity was 6/24, N8 right eye and 2/60, N unable for left eye with extensive left macular scar and hole. Vitreous cultures were negative. He received multiple IVT amphotericin B and was started on topical steroid eye drops for persistent panuveitis with systemic fluconazole. Ocular improvement was seen after switching to IVT and topical voriconazole. Despite this, his ocular condition deteriorated and he developed neovascular glaucoma requiring 3 topical antiglaucoma agents. Panretinal photocoagulation was subsequently performed. Outcomes: At 3 months’ follow-up, his vision acuity remained at 6/24 for right eye and 2/60 for the left eye. There was no recurrence of inflammation or infection in both eyes. Lessons: Voriconazole could serve as a promising broad spectrum tri-azole agent in cases of failure in first-line treatment or drug-resistant fungus.

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Section: Discussionmentioning

confidence: 85%

Chronic endogenous fungal endophthalmitis: diagnostic and treatment challenges

Talib

Yong²,

Nasaruddin³

et al. 2021

Medicine

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“…[1,7] Factors associated with poor visual outcomes include, presenting visual acuity, central location of the lesion, presence of secondary CNV, retinal detachment, and insufficient or delayed treatment. [8,6,9] The mainstay of treatment in ocular candidiasis is systemic antifungal medication such as voriconazole and fluconazole, associated to intravitreal injection of antimycotic agents (amphotericin B or voriconazole) which could be combined with pars plana vitrectomy. [2] Currently, there are no established treatment strategies for CNV in the context of candida chorioretinitis.…”

Section: Discussionmentioning

confidence: 99%

“…[16] The use of ranibizumab combined with vitrectomy has been found to be beneficial in patients with tractional retinal detachment secondary to retinal neovascularization due to endogenous fungal endophthalmitis in intravenous drug users. [9] Similarly a single intravitreal injection of ranibizumab alone has also been used in the treatment of choroidal neovascular membranes secondary to fungal endogenous endophthalmitis with good outcomes. [17] In our case a single intravitreal injection of bevacizumab was effective in resolving the CNV secondary to candida chorioretinitis, maintaining vision for a follow-up of 14 months (to our knowledge, the longest follow-up in the literature without recurrence of the disease) after the initial bevacizumab injection.…”

Section: Discussionmentioning

confidence: 99%

Bevacizumab for treatment of choroidal neovascularization secondary to candida chorioretinitis

et al. 2017

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“…10,,12,,14 One case of endogenous endophthalmitis was associated with retinal neovascularisation. 15 Another condition commonly described in the literature on chronic intravenous drug use is talc (or crystalline) retinopathy. [16][17][18][19][20] In one study on 28 patients, 82% of this population with talc retinopathy were long-term drug users.…”

Section: Intravenous Use Of Drugsmentioning

confidence: 99%

Drugs of abuse and ocular effects

Proulx

Tousignant

2021

Clinical and Experimental Optometry

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Illicit drugs and substances of abuse are increasingly used by adults and teenagers, with novel substances constantly becoming available. Many substances can cause ocular effects or visually threatening conditions. Current literature informing eye-care practitioners on these effects is scant. The present scoping review reports the ocular effects of most commonly used drugs and substances of abuse in the teenage and adult populations of North America. Ovid MEDLINE and Ovid EMBASE databases were searched for publications from 1980 to 2019 regarding ocular effects of drug use. The selected papers regarded human subjects, in either teenage or adult population and included all types of studies, including case reports. Publications in English or in French were included. Exclusion criteria were publications about the use of prescriptions drugs, drug withdrawal, and publications about the use of alcohol, tobacco, or cannabis. Some 241 papers were retained and analysed. The use of various drugs and substances can lead to damage to structures throughout the eye, including but not limited to corneal conditions, glaucoma and other optic neuropathies, maculopathies and endophthalmitis. The data presented in this review may help guide clinicians in their diagnosis and treatment of certain ocular conditions, which could otherwise not be linked to drug use.

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Retinal Neovascularization and Endogenous Fungal Endophthalmitis in Intravenous Drug Users

Cited by 6 publications

References 4 publications

Chronic endogenous fungal endophthalmitis: diagnostic and treatment challenges

Chronic endogenous fungal endophthalmitis: diagnostic and treatment challenges

Bevacizumab for treatment of choroidal neovascularization secondary to candida chorioretinitis

Drugs of abuse and ocular effects

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