Ocular Microbiology and Immunology Group
Back to OMIG Main Page

< Previous | 2023 Agenda and Abstracts | Next >

2023 OMIG Abstract

Adjunctive treatment with Rose Bengal Photodynamic Antimicrobial Therapy for Patients with Progressive Infectious Keratitis: Outcomes of the First 100 Patients

Su Jeoung Kim, Nicole Belanger, and Paulo Bispo

Massachusetts Eye and Ear / Ophthalmology, Boston, MA

Purpose: Endogenous endophthalmitis is a severe, vision-threatening ocular inflammation and represents 2-8% of all cases of endophthalmitis. Our objective is to characterize the risk factors, clinical progression, and outcomes of endogenous Candida endophthalmitis among patients who are intravenous drug users.

Methods: A retrospective chart review was performed for all 24 cases of Candida endogenous endophthalmitis (EE) who presented to MEEI between 2014-2022.

Results: Overall, 24 patients (19 male, 5 female) with the age range of 10 months to 79 (median age 34, average age 39) were diagnosed with EE. A high percentage of this population (n = 19, 79%) had history of IVDU with at least 14 (58%) reporting heroin use and 13 reporting polysubstance use including cocaine and fentanyl. Hepatitis C virus infection was the most common comorbidity (n = 15, 63%). Substantial number of these patients (n = 13, 54%) had history of incarceration, and 2 had history of homelessness. Most common presenting symptoms included decreased vision, eye pain, photophobia, eye redness, and floaters. The presenting visual acuity (VA) ranged from 20/20 to LP. Four patients had unknown presenting VA. Final best corrected visual acuity (BCVA) ranged from 20/20 to LP. Fifteen patients had improvement of VA. Three patients had worsened VA at final presentation when compared to initial presentation.

Of those who had history of IVDU, cultures positive for C. albicans comprised of 13 eyes (68%) vs non-albicans species (n = 6, 32%). Among those who had culture-positive C. albicans, 3 were female (23%) vs. 1 female (17%) in the non-albicans species group. Average age of patients was similar at 37 for the C. albicans group and 34 for the non-albicans group. Percentage of patients with VA improvement was similar at 62% for C. albicans group vs 67% for non-albicans group. Interestingly, more patients from the C. albicans group required a secondary PPV (n = 3, 23%) and more suffered from secondary sequelae (n = 7, 54%) vs. non-albicans group (n = 1, 17% and n = 2, 33%). The reasons for secondary PPV included retinal detachment, new subretinal abscesses, choroidal detachment, and epiretinal membrane with traction. Secondary ocular sequelae included cataract, hypotony, pupillary fibrosis, rebound iritis, and subretinal fluid.

Conclusions: Our study shows the patient characteristics, clinical progression, and ocular consequences of EE in patients with IVDU. Differences in outcomes among patients with culture positive for C. albicans vs. non-C. albicans group indicate further need to better understand the microbial etiology of EE to improve treatment of population at risk.

Disclosure: N

< Previous | 2023 Agenda and Abstracts | Next >