Chung Yoo-Ri, Lam Delphine, Edel Yves, Caumes Eric, March de Ribot Francesc, Fekkar Arnaud, Bodaghi Bahram, Touhami Sara
Department of Ophthalmology, Ajou University School of Medicine, Suwon, 16499, Korea.
Department of Ophthalmology, Pitié-Salpêtrière University Hospital, Sorbonne University, Paris, 75013, France.
Med Mycol. 2025 Jun 5;63(6). doi: 10.1093/mmy/myaf048.
We evaluated the characteristics and outcomes of ocular candidiasis in patients using buprenorphine intravenously. A retrospective analysis of 35 eyes of people who use drugs diagnosed with presumed ocular candidiasis between 2000 and 2017 was performed. Data on demographics, ocular findings, and microbiological results were extracted from medical records. Logistic regression was performed to identify factors of poor visual prognosis, then multivariate analysis used the variables that were statistically significant in univariate analysis. Most patients (83%) were male, with a mean duration of 7.1 ± 7.3 years from the onset of intravenous use of buprenorphine to diagnosis of ocular candidiasis. The mean best-corrected visual acuity (BCVA in logMAR) at diagnosis was 1.33 ± 0.73, improving significantly to 0.94 ± 0.91 at the last follow-up (P = .019). Diagnostic samples included aqueous humor from all patients and vitrectomy samples from 26 patients (74%), with positivity rates for Candida species culture of 23% and 27%, respectively. Extraocular sites tested positive for Candida in 54% of cases. Although representing 66% of identifications, Candida albicans was not the only identified organism. Treatment involved primarily fluconazole (91%) and intravitreal amphotericin B (69%). Poor visual outcomes correlated with low BCVA and presence of retinal detachment at baseline. Ocular candidiasis occurs in the context of chronic drug use. Diagnostic yield from ocular samples is relatively low, necessitating the investigation of extraocular infection sites or injection equipment. Poor baseline vision and retinal detachment were significant predictors of poor visual prognosis.
我们评估了静脉注射丁丙诺啡患者眼部念珠菌病的特征和预后。对2000年至2017年间被诊断为疑似眼部念珠菌病的35名吸毒者的眼睛进行了回顾性分析。从病历中提取了人口统计学、眼部检查结果和微生物学结果的数据。进行逻辑回归以确定视力预后不良的因素，然后多变量分析使用单变量分析中具有统计学意义的变量。大多数患者（83%）为男性，从开始静脉注射丁丙诺啡到诊断眼部念珠菌病的平均病程为7.1±7.3年。诊断时的平均最佳矫正视力（logMAR视力）为1.33±0.73，在最后一次随访时显著提高至0.94±0.91（P = 0.019）。诊断样本包括所有患者的房水和26名患者（74%）的玻璃体切除样本，念珠菌属培养的阳性率分别为23%和27%。54%的病例中眼外部位念珠菌检测呈阳性。虽然白色念珠菌占鉴定出的病原体的66%，但它不是唯一鉴定出的病原体。治疗主要包括氟康唑（91%）和玻璃体内注射两性霉素B（69%）。视力预后不良与基线时低最佳矫正视力和视网膜脱离有关。眼部念珠菌病发生在慢性药物使用的背景下。眼部样本的诊断阳性率相对较低，需要对眼外感染部位或注射设备进行调查。基线视力差和视网膜脱离是视力预后不良的重要预测因素。
