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Landim DFC, Arcoverde de Freitas Neto C, Rocha de Andrade Sabino L, Leite de Alencar L, Vaz RT. Selective Laser Trabeculoplasty (SLT) for IOP Control in a Patient with Bilateral Acute Iris Transillumination (BAIT). Ocul Immunol Inflamm 2024; 32:699-702. [PMID: 37093961 DOI: 10.1080/09273948.2023.2198000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/28/2023] [Indexed: 04/26/2023]
Abstract
INTRODUCTION Bilateral acute iris transillumination (BAIT) is a clinical condition characterized by acute bilateral loss of iris pigment epithelium and iris transillumination. Because of the similar presentation, it is commonly confused with anterior uveitis, making it an important differential diagnosis for this condition. CASE DESCRIPTION We report the case of a 60-year-old male patient who presented all the characteristics of BAIT after undergoing systemic treatment with moxifloxacin and that had the intraocular pressure (IOP) successfully controlled with selective laser trabeculoplasty (SLT). CONCLUSION SLT might be an effective therapeutic option and should be considered for the control of IOP in BAIT.
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Affiliation(s)
| | - Clóvis Arcoverde de Freitas Neto
- Department of Ophthalmology, Fundação Santa Luzia, Recife, Brazil
- Department of Ophthalmology, Hospital de Olhos Santa Luzia, Recife, Brazil
| | | | | | - Rinalva Tenório Vaz
- Department of Ophthalmology, Fundação Santa Luzia, Recife, Brazil
- Department of Ophthalmology, Hospital de Olhos Santa Luzia, Recife, Brazil
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Mueller A, Lam I, Kishor K, Lee RK, Bhattacharya S. Secondary glaucoma: Toward interventions based on molecular underpinnings. WIREs Mech Dis 2024; 16:e1628. [PMID: 37669762 DOI: 10.1002/wsbm.1628] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 09/07/2023]
Abstract
Glaucoma is a heterogeneous group of progressive diseases that leads to irreversible blindness. Secondary glaucoma refers to glaucoma caused by a known underlying condition. Pseudoexfoliation and pigment dispersion syndromes are common causes of secondary glaucoma. Their respective deposits may obstruct the trabecular meshwork, leading to aqueous humor outflow resistance, ocular hypertension, and optic neuropathy. There are no disease-specific interventions available for either. Pseudoexfoliation syndrome is characterized by fibrillar deposits (pseudoexfoliative material) on anterior segment structures. Over a decade of multiomics analyses taken together with the current knowledge on pseudoexfoliative glaucoma warrant a re-think of mechanistic possibilities. We propose that the presence of nucleation centers (e.g., vitamin D binding protein), crosslinking enzymes (e.g., transglutaminase 2), aberrant extracellular matrix, flawed endocytosis, and abnormal aqueous-blood barrier contribute to the formation of proteolytically resistant pseudoexfoliative material. Pigment dispersion syndrome is characterized by abnormal iridolenticular contact that disrupts iris pigment epithelium and liberates melanin granules. Iris melanogenesis is aberrant in this condition. Cytotoxic melanogenesis intermediates leak out of melanosomes and cause iris melanocyte and pigment epithelium cell death. Targeting melanogenesis can likely decrease the risk of pigmentary glaucoma. Skin and melanoma research provides insights into potential therapeutics. We propose that specific prostanoid agonists and fenofibrates may reduce melanogenesis by inhibiting cholesterol internalization and de novo synthesis. Additionally, melatonin is a potent melanogenesis suppressor, antioxidant, and hypotensive agent, rendering it a valuable agent for pigmentary glaucoma. In pseudoexfoliative glaucoma, where environmental insults drive pseudoexfoliative material formation, melatonin's antioxidant and hypotensive properties may offer adjunct therapeutic benefits. This article is categorized under: Neurological Diseases > Molecular and Cellular Physiology.
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Affiliation(s)
- Anna Mueller
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Isabel Lam
- Idaho College of Osteopathic Medicine, Meridian, Idaho, USA
| | - Krishna Kishor
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
- Miami Integrative Metabolomics Research Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Richard K Lee
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
- Miami Integrative Metabolomics Research Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sanjoy Bhattacharya
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
- Miami Integrative Metabolomics Research Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
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Altan C, Basarir B, Bayraktar S, Tugal-Tutkun I. Bilateral Acute Depigmentation of Iris (BADI) and Bilateral Acute Iris Transillumination (BAIT)Following Acute COVID-19 Infection. Ocul Immunol Inflamm 2022:1-6. [PMID: 36083696 DOI: 10.1080/09273948.2022.2103832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
PURPOSE To report the presenting features and outcomes in patients who developed bilateral acute iris transillumination (BAIT) or bilateral acute depigmentation of iris (BADI) following acute COVID-19 infection. METHODS Thirty two eyes of 16 patients were reviewed retrospectively. The severity of COVID-19 infection, use of antibiotics, time of onset of ocular symptoms; ocular signs, the course and surgical procedures were recorded. RESULTS 24 eyes of 12 BAIT and eight eyes of four consecutive BADI patients were included. The mean time between infection and onset of ocular symptoms was 2.5±1.1 weeks. Nine patients were treated with oral moxifloxacin for COVID-19 prior to presentation. Trabeculectomy was performed in 7 eyes (21.8%) of 5 BAIT patients; in the postoperative follow-up, IOP was controlled without medication in 6 eyes, with medication in 1 eye. CONCLUSION BADI and BAIT can also develop after COVID-19 infection. A significant proportion of BAIT patients may require glaucoma surgery.
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Affiliation(s)
- Cigdem Altan
- Beyoglu Eye Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Berna Basarir
- Beyoglu Eye Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Serife Bayraktar
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ilknur Tugal-Tutkun
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.,Department of Ophthalmology, Bayrampasa Eye Hospital, Istanbul, Turkey
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Klonner J, Salchow D. [Unusual anisocoria]. Ophthalmologe 2021; 118:597-599. [PMID: 32588124 PMCID: PMC8187173 DOI: 10.1007/s00347-020-01153-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Eine 53-jährige Patientin beklagte erhöhte Blendempfindlichkeit 3 Wochen nach Einnahme von Moxifloxacin-Tabletten bei Infekt der oberen Atemwege. Es bestand eine Anisokorie, die Pupillenreaktion, sowohl auf Licht als auch auf Naheinstellung, war aufgehoben. In der Untersuchung des vorderen Augenabschnittes fielen beidseits ausgeprägte Iristransilluminationsdefekte (ITD) auf. Wir diagnostizierten ein BAIT-Syndrom (bilaterales akutes Iristransilluminationssyndrom). Dies ist ein seltenes Syndrom, welches mit einer massiven Depigmentierung der Iris sowie einer Atrophie der Irismuskulatur einhergeht. Risikofaktor für die Entstehung eines BAIT-Syndroms scheint die orale Einnahme von Antibiotika, insbesondere Moxifloxacin, im Rahmen eines Infektes der oberen Atemwege zu sein, aber auch spontan auftretende Fälle sind beschrieben. Betroffen sind v. a. Frauen mittleren Alters. Die genaue Ursache des BAIT-Syndroms ist bisher unklar. Diskutiert wird ein möglicher Einfluss der Konzentration des Antibiotikums im Glaskörper. Differenzialdiagnostisch muss bei Iristransilluminationsdefekten insbesondere auch an Albinismus, intraokuläre Entzündungen, Pseudoexfoliationssyndrom und Pigmentdispersionssyndrom gedacht werden. Eine spezifische Therapie des BAIT-Syndroms besteht bisher nicht. Erhöhte Lichtempfindlichkeit und ein Post-BAIT-Glaukom können mögliche Komplikationen sein. Die Kenntnis des seltenen BAIT-Syndroms kann im klinischen Alltag hilfreich bei der differenzialdiagnostischen Einordnung einer Anisokorie sein und ggf. zur Vermeidung unnötiger diagnostischer Schritte beitragen.
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Affiliation(s)
- Jan Klonner
- Universitäts-Augenklinik, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
| | - Daniel Salchow
- Universitäts-Augenklinik, Leitung der Sektion Kinderaugenheilkunde, Strabologie/Orthoptik, Neuroophthalmologie, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
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Wey S, Flamendorf J, Sinha S, Lee D. Surgical Management of Glaucoma Secondary to Bilateral Acute Iris Transillumination: A Role for Gonioscopy-assisted Transluminal Trabeculotomy. J Ophthalmic Vis Res 2021; 16:122-126. [PMID: 33520135 PMCID: PMC7841269 DOI: 10.18502/jovr.v16i1.8258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 10/16/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose We report a case of bilateral acute iris transillumination (BAIT) in a young woman associated with ocular hypertension which eventually progressed to glaucoma that was treated with gonioscopy-assisted transluminal trabeculectomy (GATT). Case Report A 37-year-old otherwise healthy female presented with intermittently red and inflamed eyes and blurred vision. She was treated with oral moxifloxacin months prior to presentation. Iris transillumination defects, a pigmented anterior chamber reaction, the absence of keratic precipitates, and a history of upper respiratory infection treated with an oral fluoroquinolone prompted the diagnosis of BAIT. Intraocular pressure (IOP) remained uncontrolled on multiple glaucoma medications. Following the development of new visual field defects, indicating progression to glaucoma, GATT with cataract extraction was performed. Conclusion Although surgical intervention is rare with BAIT, our case demonstrates that GATT may be used effectively in those patients needing better IOP control before considering incisional glaucoma surgery.
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Affiliation(s)
- Stephanie Wey
- Department of Ophthalmology, University of Cincinnati, OH, USA
| | | | - Sapna Sinha
- Glaucoma Service, Wills Eye Hospital, PA, USA
| | - Daniel Lee
- Glaucoma Service, Wills Eye Hospital, PA, USA
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Long-term Results of Trabeculectomy With Mitomycin-C in Patients With Bilateral Acute Iris Transillumination. J Glaucoma 2019; 28:797-802. [DOI: 10.1097/ijg.0000000000001309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Perone JM, Chaussard D, Hayek G. Bilateral acute iris transillumination (BAIT) syndrome: literature review. Clin Ophthalmol 2019; 13:935-943. [PMID: 31239635 PMCID: PMC6556534 DOI: 10.2147/opth.s167449] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 04/09/2019] [Indexed: 01/01/2023] Open
Abstract
The authors conducted a literature review about bilateral acute iris transillumination (BAIT) syndrome, a new and relatively unknown syndrome that should be described and made known to the greatest number to avoid potential diagnostic and therapeutic errors. The first cases date back only to 2004 and a total of 79 cases have been published to date, mainly in Europe and especially in Turkey and Belgium. It mainly affects young women between the ages of 30 and 50, and symptoms are often preceded by an upper airway infection. There is also a majority of cases where the onset of the syndrome follows oral intake of moxyfloxacin. The clinical signs are dominated by strong photophobia, secondary to a spectacular transillumination of the iris. Other classical symptoms are conjunctival infection, eye pain, blurred vision, temporary ocular hypertonia, fixed mid-dilated pupils, and pigment dispersion in the anterior chamber with pigmentary deposits in the trabecular meshwork in gonioscopy, symptoms that may be mistaken for uveitis. After a few weeks or months of evolution, persistent sequelae were pupillary atony and chronic and bilateral transillumination of the iris, leading to significant photophobia and sometimes persistent ocular hypertension. The BAIT syndrome is close to the bilateral acute depigmentation of the iris (BADI) syndrome, which is similar to BAIT but lacks associated transillumination. A few cases of patients with BAIT syndrome on one eye and BADI syndrome on the contralateral eye have been described, which confirms some form of link between the two clinical entities.
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Affiliation(s)
- Jean Marc Perone
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, Metz, France
| | - Dimitri Chaussard
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, Metz, France
| | - George Hayek
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, Metz, France
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