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Diffuse Retinal Ischemia Following Intravenous Crushed Oxymorphone Abuse

Rohan J. Shah, MD1; Edward F. Cherney, MD1
[+] Author Affiliations
1Vanderbilt Eye Institute, Department of Ophthalmology and Visual Sciences, Vanderbilt University School of Medicine, Nashville, Tennessee
JAMA Ophthalmol. 2014;132(6):780-781. doi:10.1001/jamaophthalmol.2014.324.
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A unique case of diffuse retinal ischemia following intravenous abuse of crushed extended-release oxymorphone hydrochloride (Opana ER) is reported. This case highlights a potentially blinding condition as a result of retinal vascular endothelial injury following intravenous abuse of a medication intended for oral use.

Article InformationCorresponding Author: Edward F. Cherney, MD, Vanderbilt Eye Institute, 2311 Pierce Ave, Nashville, TN 37232 (edward.cherney@vanderbilt.edu).

Author Contributions: Drs Shah and Cherney had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Shah, Cherney.

Acquisition, analysis, or interpretation of data: Shah, Cherney.

Drafting of the manuscript: Shah.

Critical revision of the manuscript for important intellectual content: Shah, Cherney.

Administrative, technical, or material support: Shah, Cherney.

Study supervision: Cherney.

Conflict of Interest Disclosures: None reported.

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Figure 2.
Spectral-Domain Optical Coherence Tomographic Images and Color Fundus Photographs at Follow-up

Spectral-domain optical coherence tomographic images of the patient’s right (A) and left (B) maculae reveal diffuse inner retinal thinning from ischemia and loss of normal foveal contour. Montage color fundus photographs of the patient’s right (C) and left (D) eyes at the most recent follow-up delineate increased arteriovenous sheathing and ischemia with peripheral panretinal photocoagulation scars.

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Figure 1.
Color Fundus Photographs and Fluorescein Angiograms

Montage color fundus photographs demonstrate arteriovenous tortuosity, scattered hemorrhages, and ischemia in the patient’s right eye (A) and arteriovenous tortuosity, disc neovascularization, cotton-wool spots and hemorrhages, and ischemia in the patient’s left eye (B). Montage fluorescein angiograms of the patient’s right (C) and left (D) eyes reveal diffuse retinal ischemia and capillary dropout.

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