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Comment & Response
December 2017

Association of Endogenous Endophthalmitis With Intravenous Drug Use: An Emerging Public Health Challenge

Author Affiliations
  • 1Department of Ophthalmology, Southern California Permanente Medical Group, Baldwin Park, California
  • 2Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
  • 3Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
JAMA Ophthalmol. 2017;135(12):1457. doi:10.1001/jamaophthalmol.2017.4342

To the Editor We read with great interest the informative and insightful series by Tirpack et al1 on intravenous drug use (IVDU)–associated endogenous endophthalmitis in New England,1 which reports 10 eyes of 10 patients over a 2-year period and highlights an increasingly common cause of ocular morbidity. Our 2017 series of IVDU-associated endophthalmitis (fungal and bacterial etiologies) of 32 eyes of 30 patients during an 8-year period also took place in a Boston, Massachusetts, tertiary care eye center but produced some noteworthy differences.2 All patients described by Tirpack et al1 had fungal infections, which was by design because 2 cases with equivocal etiology were excluded. Although IVDU-associated endophthalmitis is classically associated with fungus, clinicians should be mindful of the possibility of bacterial causes because 16% of eyes had a bacterial etiology in our series.2 Broad-spectrum treatment should be considered given the potentially catastrophic consequences of untreated bacterial endophthalmitis, with further antimicrobial therapy tailored to patients’ culture results and clinical course.

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