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Comment & Response
December 2017

Endogenous Endophthalmitis Associated With Intravenous Drug Use—Reply

Author Affiliations
  • 1Tufts University School of Medicine, Department of Vitreoretinal Surgery, New England Eye Center, Boston, Massachusetts
JAMA Ophthalmol. 2017;135(12):1457-1458. doi:10.1001/jamaophthalmol.2017.4357

In Reply We thank Modjtahedi et al for their correspondence regarding our 2 institutions’ publications on intravenous drug use (IVDU)–associated endophthalmitis in the New England community.1,2 Modjtahedi et al describe their retrospective experience with 30 cases of IVDU-associated endophthalmitis over an 8-year period between 2006 and 2014.1 Our series focuses specifically on 10 cases of fungal endophthalmitis resulting from intravenous drug use seen at our institution from May 2014 to May 2016, which serves to complement their analysis.2 Heroin was the most commonly used intravenous substance in both series: 60% of patients in Tirpack et al2 and 57% in Modjtahedi et al.1 While the epidemiologic trends of IVDU-associated endophthalmitis were not specifically addressed in the Modjtahedi et al article, our analysis did reveal a sharp increase in the number of cases seen at our institution (3 cases from May 2012 to April 2014 to 10 cases from May 2014 to May 2016).2 This noted increase in cases of IVDU-associated endophthalmitis mirrors regional trends of rising heroin-associated mortality and hospital admissions throughout New England. Both publications highlight this growing public health crisis and serve to guide ophthalmologists on appropriate diagnosis, management, and treatment of this severe intraocular infection.