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Li Y, Chen L, Tang X, Luo L, Wang C. Safety analysis of fluoroquinolone drugs in elderly patients over 65 based on FAERS. Expert Opin Drug Saf 2024:1-13. [PMID: 39269701 DOI: 10.1080/14740338.2024.2392862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/02/2024] [Accepted: 07/05/2024] [Indexed: 09/15/2024]
Abstract
OBJECTIVE This study investigates adverse drug event (ADE) reports from the FAERS related to FQs drugs in patients aged 65 and older. The findings aim to guide the rational clinical use of these drugs in elderly patients. METHODS We employed Reporting Odds Ratio (ROR) and Proportional Reporting Ratio (PRR) methods to analyze ADE reports for the representative FQ drugs from Q1 2015 to Q4 2023, covering 36 quarters. RESULTS The analysis identified 6883 ADE cases for ciprofloxacin, 5866 for levofloxacin, 1498 for moxifloxacin, and 317 for ofloxacin. Moxifloxacin showed higher incidences of Cardiac disorders and Psychiatric disorders ADEs (4.01%, 23.11%). Ciprofloxacin and levofloxacin showed higher ADE rates in musculoskeletal and connective tissue diseases (20.18% and 26.97%) compared to moxifloxacin (3.62%) and ofloxacin (9.25%). Additionally, moxifloxacin and ofloxacin showed higher ADE rates for eye disorders (10.61% and 15.03%). CONCLUSION Different FQs exhibit varying ADE profiles across cardiovascular, vascular and lymphatic, renal and urinary, psychiatric, musculoskeletal and connective tissue, and ocular systems. Patients with underlying systemic diseases should avoid FQs with higher ADE risks for their conditions. Personalized medication plans for elderly patients should also be strengthened.
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Affiliation(s)
- Yanwei Li
- Department of Pharmacy, People's Hospital of Ganzi Tibetan Autonomous Prefecture, Kangding, Sichuan, China
| | - Li Chen
- Department of Pharmacology, Faculty of Medicine, UPV/EHU, Leioa, Spain
- Department of Pharmacy/Evidence-based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiting Tang
- Department of Pharmacy, People's Hospital of Ganzi Tibetan Autonomous Prefecture, Kangding, Sichuan, China
| | - Lan Luo
- Department of Pharmacy, People's Hospital of Ganzi Tibetan Autonomous Prefecture, Kangding, Sichuan, China
| | - Chengliang Wang
- Department of Pharmacy, People's Hospital of Ganzi Tibetan Autonomous Prefecture, Kangding, Sichuan, China
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2
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Li Y, Wang J, Wang C, Chen L. Safety analysis of quinolones use in minors-based on the FAERS database. Front Med (Lausanne) 2024; 11:1437376. [PMID: 39267976 PMCID: PMC11390674 DOI: 10.3389/fmed.2024.1437376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 08/13/2024] [Indexed: 09/15/2024] Open
Abstract
Objective This study utilizes the FDA Adverse Event Reporting System (FAERS) to investigate adverse drug event (ADE) signals linked to quinolones use (ciprofloxacin, moxifloxacin, levofloxacin, ofloxacin) in minors, offering insights for clinical use. Methods Minors were categorized into four age groups. ADE reports for these quinolones from the first quarter of 2015 to the third quarter of 2023 were extracted from the FAERS database. Data analysis used reporting odds ratio (ROR) and the MHRA method. Results Most ADE cases in minors involved ciprofloxacin (575)and levofloxacin (477). In the infant group, various injury, poisoning, and procedural complication events were more frequently associated with ciprofloxacin, levofloxacin, and moxifloxacin (19.83%, 31.25%, and 100.00%, respectively). In the preschool children group, psychiatric disorders were more frequently reported with levofloxacin and ofloxacin use (59.00% and 47.62%, respectively). Ocular disorders were notably associated with moxifloxacin in the children group (62.50%), In the adolescent group, more gastrointestinal diseases occurred with ciprofloxacin (12.96%). Conclusion ADE occurrence with quinolones in minors varies by age. Strict adherence to indications, rational use, avoiding prolonged use, and monitoring for short-term reactions are essential. Enhanced monitoring of interactions and drug education are crucial to reducing ADE.
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Affiliation(s)
- Yanwei Li
- Department of Pharmacy, People's Hospital of Ganzi Tibetan Autonomous Prefecture, Kangding, Sichuan, China
| | - Jing Wang
- Department of Pharmacy, Sichuan Mianyang 404 Hospital, Mianyang, Sichuan, China
| | - ChengLiang Wang
- Department of Pharmacy, People's Hospital of Ganzi Tibetan Autonomous Prefecture, Kangding, Sichuan, China
| | - Li Chen
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Pharmacology, Faculty of Medicine and Nursing, University of the Basque Country, Leioa, Spain
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3
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Yu S, Sodhi M, Rezaeianzadeh R, Eadie B, Etminan M. Increased risk of pigmentary degeneration of the iris and pigmentary glaucoma with fluoroquinolone antibiotics. Eye (Lond) 2024:10.1038/s41433-024-03282-z. [PMID: 39069553 DOI: 10.1038/s41433-024-03282-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 06/26/2024] [Accepted: 07/22/2024] [Indexed: 07/30/2024] Open
Abstract
PURPOSE Fluoroquinolones are popular antibiotics used for a myriad of conditions including ocular procedures. Despite numerous case reports of acute pigmentary degeneration of the iris with fluoroquinolone use, a pharmacoepidemiological study has not been performed to examine and quantify this risk. DESIGN Retrospective cohort study with a case-control analysis. PARTICIPANTS A cohort of 1,231,881 new users of oral or topical moxifloxacin, levofloxacin, and azithromycin were followed to first diagnosis of pigmentary degeneration of the iris or pigmentary glaucoma. Four controls were selected for each case using density sampling, matching on age and calendar time. METHODS Users of oral or topical moxifloxacin were compared to levofloxacin and azithromycin, a negative control drug from a separate class. MAIN OUTCOMES AND MEASURES First incidence of pigmentary degeneration of the iris or pigmentary glaucoma. RESULTS The cohort was comprised of 1,231,881 new users of topical or oral levofloxacin, moxifloxacin, or azithromycin. 542 cases of pigmentary degeneration of the iris and 460 cases of pigmentary glaucoma were identified. The incidence of iris pigmentary degeneration or pigmentary glaucoma for topical moxifloxacin was 10.2/1000 person years compared to 2.6/1000 person years for topical azithromycin. Current topical moxifloxacin users had the highest adjusted IRR for pigmentary degeneration of the iris (IRR = 6.81, [95%CI:2.00-23.18]) and pigmentary glaucoma (IRR = 4.07 [95%CI:1.42-11.62]) respectively. CONCLUSIONS The study findings suggest that patients using topical moxifloxacin may have increased risk of developing pigmentary degeneration of the iris and pigmentary glaucoma although the absolute increase was low. Future studies are needed to confirm this association.
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Affiliation(s)
- Sabrina Yu
- Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Mohit Sodhi
- Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, BC, Canada
| | | | - Brennan Eadie
- Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada
| | - Mahyar Etminan
- Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, BC, Canada.
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4
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Brown JP, Wing K, Evans SJ, Leyrat C, Mansfield KE, Smeeth L, Wong AYS, Yorston D, Galwey NW, Douglas IJ. Systemic Fluoroquinolone Use and Risk of Uveitis or Retinal Detachment. JAMA Ophthalmol 2024; 142:636-645. [PMID: 38814618 PMCID: PMC11140578 DOI: 10.1001/jamaophthalmol.2024.1712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 04/07/2024] [Indexed: 05/31/2024]
Abstract
Importance Fluoroquinolone use has been associated with increased risk of uveitis and retinal detachment in noninterventional studies, but the findings have been conflicting and causality is unclear. Objective To estimate the association of systemic fluoroquinolone use with acute uveitis or retinal detachment, using multiple analyses and multiple databases to increase the robustness of results. Design, Setting, and Participants This cohort study used data from the Clinical Practice Research Datalink Aurum and GOLD UK primary care records databases, which were linked to hospital admissions data. Adults prescribed a fluoroquinolone or a comparator antibiotic, cephalosporin, between April 1997 and December 2019 were included. Adults with uveitis or retinal detachment were analyzed in a separate self-controlled case series. Data analysis was performed from May 2022 to May 2023. Exposures Systemic fluoroquinolone or comparator antibiotic. Main Outcomes and Measures The primary outcome was a diagnosis of acute uveitis or retinal detachment. Hazard ratios (HRs) were estimated in the cohort study for the association of fluoroquinolone prescription with either uveitis or retinal detachment, using stabilized inverse probability of treatment weighted Cox regression. Rate ratios (RRs) were estimated in the self-controlled case series, using conditional Poisson regression. Estimates were pooled across databases using fixed-effects meta-analysis. Results In total, 3 001 256 individuals in Aurum (1 893 561 women [63.1%]; median [IQR] age, 51 [35-68] years) and 434 754 in GOLD (276 259 women [63.5%]; median [IQR] age, 53 [37-70] years) were included in the cohort study. For uveitis, the pooled adjusted HRs (aHRs) for use of fluoroquinolone vs cephalosporin were 0.91 (95% CI, 0.72-1.14) at first treatment episode and 1.07 (95% CI, 0.92-1.25) over all treatment episodes. For retinal detachment, the pooled aHRs were 1.37 (95% CI, 0.80-2.36) at first treatment episode and 1.18 (95% CI, 0.84-1.65) over all treatment episodes. In the self-controlled case series, for uveitis, the pooled adjusted RRs (aRRs) for fluoroquinolone use vs nonuse were 1.13 (95% CI, 0.97-1.31) for 1 to 29 days of exposure, 1.16 (95% CI, 1.00-1.34) for 30 to 59 days, and 0.98 (95% CI, 0.74-1.31) for 60 days for longer. For retinal detachment, pooled aRRs for fluoroquinolone use vs nonuse were 1.15 (95% CI, 0.86-1.54) for 1 to 29 days of exposure, 0.94 (95% CI, 0.69-1.30) for 30 to 59 days, and 1.03 (95% CI, 0.59-1.78) for 60 days or longer. Conclusions and Relevance These findings do not support an association of systemic fluoroquinolone use with substantively increased risk of uveitis or retinal detachment. Although an association cannot be completely ruled out, these findings indicate that any absolute increase in risk would be small and, hence, of limited clinical importance.
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Affiliation(s)
- Jeremy P Brown
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kevin Wing
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Stephen J Evans
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Clémence Leyrat
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kathryn E Mansfield
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Liam Smeeth
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Angel Y S Wong
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David Yorston
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, United Kingdom
| | - Nicholas W Galwey
- Research and Development, GSK Medicines Research Centre, GSK, Stevenage, United Kingdom
| | - Ian J Douglas
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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5
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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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6
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Gaur S, Sindhu N, Singh DV, Bhattacharya M, Sharma A, Shinde D. COVID-19-related bilateral acute de-pigmentation of iris with ocular hypertension. Indian J Ophthalmol 2022; 70:3136-3139. [PMID: 35918989 DOI: 10.4103/ijo.ijo_75_22] [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: 11/05/2022] Open
Abstract
A 43-year-old male patient presented with acute blurring of vision in both eyes associated with photophobia, redness, and mild pain following coronavirus disease 2019 (Covid-19) infection. Clinical examination revealed extensive pigment dusting in the corneal endothelium and the trabecular meshwork with de-pigmentation bands in the iris periphery. The patient was managed empirically with topical anti-glaucoma medications for high intra-ocular pressure. The patient was prescribed systemic antibiotics including cephalosporins and amoxicillin for respiratory symptoms. A rare condition called bilateral acute de-pigmentation of iris (BADI) was suspected after ruling out common entities, for example, viral kerato-uveitis, pigment dispersion syndrome, and Fuchs iridocyclitis. Covid-19 infection and systemic antibiotics including cephalosporins have shown to cause BADI in the literature. The patient responded well with good outcome.
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Affiliation(s)
- Sandhya Gaur
- Department of Ophthalmology, Cornea Anterior Segment Services, Eye-Q Super Speciality Eye Hospitals, Gurugram, Haryana, India
| | - Narottama Sindhu
- Department of Ophthalmology, Cornea Anterior Segment Services, Eye-Q Super Speciality Eye Hospitals, Gurugram, Haryana, India
| | - Deependra Vikram Singh
- Department of Ophthalmology, Cornea Anterior Segment Services, Eye-Q Super Speciality Eye Hospitals, Gurugram, Haryana, India
| | - Mainak Bhattacharya
- Department of Ophthalmology, Cornea Anterior Segment Services, Eye-Q Super Speciality Eye Hospitals, Gurugram, Haryana, India
| | - Ajay Sharma
- Department of Ophthalmology, Cornea Anterior Segment Services, Eye-Q Super Speciality Eye Hospitals, Gurugram, Haryana, India
| | - Dattatraya Shinde
- Department of Ophthalmology, Cornea Anterior Segment Services, Eye-Q Super Speciality Eye Hospitals, Gurugram, Haryana, India
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7
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Arora A. Commentary: COVID-19-related bilateral acute depigmentation of iris with ocular hypertension. Indian J Ophthalmol 2022; 70:3140. [PMID: 35918990 DOI: 10.4103/ijo.ijo_1297_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Atul Arora
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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8
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Hinkle DM. Re-assessing Evidence for Adverse Ocular Reactions Associated with Fluoroquinolones: Implications for Intracameral Use. Ocul Immunol Inflamm 2022; 30:208-209. [PMID: 32783748 DOI: 10.1080/09273948.2020.1775857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- David M Hinkle
- Department of Ophthalmology and Visual Sciences, West Virginia University Eye Institute, Morgantown, West Virginia, USA
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9
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Rivera-Valdivia N, Arteaga-Rivera K, Reyes-Guanes J, Neira-Segura N, de-la-Torre A. Severe sequelae in bilateral acute iris transillumination syndrome secondary to the use of oral moxifloxacin: a case report. J Med Case Rep 2021; 15:462. [PMID: 34537056 PMCID: PMC8449864 DOI: 10.1186/s13256-021-03075-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 08/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background Moxifloxacin is a fourth-generation fluoroquinolone used as a second-line treatment for multiple bacterial infections. Uveitis has been described as an adverse effect related to this medication. Although several case reports have been published describing uveitis and bilateral acute iris transillumination syndrome related to moxifloxacin, we present a unique case of a patient with severe sequelae associated with bilateral acute iris transillumination syndrome secondary to the use of oral moxifloxacin. Case presentation A 45-year-old Colombian hispanic female presented bilateral conjunctival hyperemia, decreased visual acuity, blurred vision, photophobia, and ocular pain after 15 days of treatment with systemic moxifloxacin for an upper tract respiratory infection. The patient presented unilateral anterior chamber pigment dispersion, mydriatic and nonreactive pupils, extensive iris transillumination defects, and secondary glaucoma. Blood and aqueous humor tests were negative for infectious and autoimmune diseases. Moxifloxacin-induced bilateral acute iris transillumination syndrome was diagnosed. Permanent sequelae such as ocular pain, photophobia, and focus difficulty secondary to severe bilateral iridian atrophy and inability of synkinetic reflex were left. Additionally, glaucoma was diagnosed, and Ahmed valve implantation was required. Conclusions We should be aware of the possible association between moxifloxacin and bilateral acute iris transillumination syndrome. A detailed anamnesis, adequate examination, and laboratory tests are necessary to reach an early diagnosis and treatment to avoid unnecessary therapies. Larger studies should be carried out to understand the pathophysiology, diagnosis, management, and sequelae of the disease.
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Affiliation(s)
- Nicolás Rivera-Valdivia
- Escuela Barraquer Research Group, Escuela Superior de Oftalmología - Instituto Barraquer de América, Avenida Calle 100 # 18A - 51, Bogotá, Colombia
| | - Karla Arteaga-Rivera
- Escuela Barraquer Research Group, Escuela Superior de Oftalmología - Instituto Barraquer de América, Avenida Calle 100 # 18A - 51, Bogotá, Colombia
| | - Juliana Reyes-Guanes
- Escuela Barraquer Research Group, Escuela Superior de Oftalmología - Instituto Barraquer de América, Avenida Calle 100 # 18A - 51, Bogotá, Colombia
| | - Natalia Neira-Segura
- Escuela Barraquer Research Group, Escuela Superior de Oftalmología - Instituto Barraquer de América, Avenida Calle 100 # 18A - 51, Bogotá, Colombia
| | - Alejandra de-la-Torre
- NeURos research group, Escuela de Medicina y Ciencias de la salud, Universidad del Rosario, Carrera 24 # 63 C 69, Bogotá, Colombia.
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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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11
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Toxic Anterior Segment Syndrome with Intracameral Moxifloxacin: Case Report and Review of the Literature. Case Rep Ophthalmol Med 2021; 2021:5526097. [PMID: 33747588 PMCID: PMC7943300 DOI: 10.1155/2021/5526097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/10/2021] [Accepted: 02/19/2021] [Indexed: 11/18/2022] Open
Abstract
A case of severe anterior segment toxicity secondary to high-volume, undiluted intracameral moxifloxacin for endophthalmitis prophylaxis is reported. We examine the other reported cases of toxicity after intracameral moxifloxacin, as well as iris depigmentation and transillumination syndromes after oral and topical fluoroquinolone exposure. Additionally, we review the literature on safety, efficacy, and appropriate dosing of intracameral antibiotics with a focus on moxifloxacin.
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12
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Abdalla Elsayed MEA, Kozak I. Pharmacologically induced uveitis. Surv Ophthalmol 2021; 66:781-801. [PMID: 33440194 DOI: 10.1016/j.survophthal.2021.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 12/31/2020] [Accepted: 01/04/2021] [Indexed: 12/26/2022]
Abstract
Treatments of numerous systemic and local diseases of different etiologies may be accompanied by an unwanted side effect in the form of uveitis. We inform readers about medications that have the potential to cause uveitis and analyze the strength of association of these medications with uveitis. Subsequently, cessation of medication or appropriate treatment can be individualized for each patient for the purpose of preventing further damage to tissue structure and function. Being aware of these associations, physicians may readily identify medications that may cause uveitis and avoid expensive and unnecessary clinical and laboratory testing.
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Affiliation(s)
| | - Igor Kozak
- Moorfields Eye Hospitals UAE, Abu Dhabi, United Arab Emirates.
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13
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Iqbal KM, Hay MW, Emami-Naeini P. Medication-induced Uveitis: An Update. J Ophthalmic Vis Res 2021; 16:84-92. [PMID: 33520131 PMCID: PMC7841282 DOI: 10.18502/jovr.v16i1.8254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 12/04/2020] [Indexed: 01/21/2023] Open
Abstract
Drug-induced uveitis is an uncommon but important cause of ocular inflammation. Uveitis can be seen in association with various systemic, topical, and intraocular medications. In this article, we review common medications associated with uveitis. Most cases of drug-induced uveitis resolve with termination of the suspected medication with or without administration of topical or systemic steroids. It is important for clinicians to readily identify medications that may cause uveitis in order to provide rapid treatment, avoid consequences of longstanding inflammation, and prevent costly and excessive laboratory testing.
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Affiliation(s)
- Kashif M Iqbal
- (KM Iqbal and MW Hay contributed equally to this paper.)
| | - Madeline W Hay
- University of California Riverside School of Medicine, Riverside, CA
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14
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Peñaranda-Henao M, Reyes-Guanes J, Muñoz-Ortiz J, Gutiérrez ÁM, De-La-Torre A. Anterior Uveitis Due to Intracameral Moxifloxacin: A Case Report. Ocul Immunol Inflamm 2020; 29:1366-1369. [DOI: 10.1080/09273948.2020.1757120] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | - Juliana Reyes-Guanes
- NeURos Research Group, Escuela De Medicina Y Ciencias De La Salud, Universidad Del Rosario, Bogotá, Colombia
| | - Juliana Muñoz-Ortiz
- Escuela Superior De Oftalmología, Instituto Barraquer De América, Bogotá, Colombia
- NeURos Research Group, Escuela De Medicina Y Ciencias De La Salud, Universidad Del Rosario, Bogotá, Colombia
| | | | - Alejandra De-La-Torre
- NeURos Research Group, Escuela De Medicina Y Ciencias De La Salud, Universidad Del Rosario, Bogotá, Colombia
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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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Kawali A, Mahendradas P, Shetty R. Acute depigmentation of the iris: a retrospective analysis of 22 cases. Can J Ophthalmol 2019; 54:33-39. [DOI: 10.1016/j.jcjo.2018.03.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 03/16/2018] [Accepted: 03/27/2018] [Indexed: 10/16/2022]
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Alhabshan RN, Mansour TN. Association between oral fluoroquinolone use and lateral canthal tendon rupture: case report. Orbit 2018; 37:358-360. [PMID: 29303391 DOI: 10.1080/01676830.2017.1423357] [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: 07/04/2017] [Accepted: 12/29/2017] [Indexed: 06/07/2023]
Abstract
It is well established and documented that fluoroquinolone use is associated with the development of tendinopathy. However, little is known about the possible effects of this class of antibiotics on the orbit. We present a case of lateral canthal tendon rupture that presented with an acute right lower eyelid ectropion in a young, renal compromised patient in the setting of recent fluoroquinolone use for pneumonia. Eye care clinicians need to be aware of the possible effects of fluoroquinolones on the eyelids.
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Affiliation(s)
- Rashed N Alhabshan
- a Department of Ophthalmology , The George Washington University School of Medicine and Health Sciences , Washington , DC , USA
| | - Tamer N Mansour
- a Department of Ophthalmology , The George Washington University School of Medicine and Health Sciences , Washington , DC , USA
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Atilgan CU, Kosekahya P, Caglayan M, Berker N. Bilateral acute depigmentation of iris: 3-year follow-up of a case. Ther Adv Ophthalmol 2018; 10:2515841418787988. [PMID: 30046770 PMCID: PMC6056785 DOI: 10.1177/2515841418787988] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/11/2018] [Indexed: 11/16/2022] Open
Abstract
Bilateral acute depigmentation of the iris (BADI) usually affecting young women,
is a newly defined clinical diagnosis with bilateral symmetrical pigment loss of
iris stroma without iris transillumination defect. Herein, we want to share the
results of a 3-year-long follow-up of a 23-year old female patient with BADI.
She was admitted to our clinic with a complaint of discoloration of both her
brown irises. An ocular evaluation of the patient revealed symmetrical pigment
deposition in trabecular meshwork. No iris transillumination defect, pupillary
sphincter paralysis, keratic precipitates, and inflammatory reaction in anterior
chamber were seen. The depigmented iris stroma became repigmented symmetrically
after 3-year follow-up period. Although it is rare, BADI should be considered in
the differential diagnosis of the diseases with bilateral iris
depigmentation.
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Affiliation(s)
| | - Pinar Kosekahya
- Ankara Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Mehtap Caglayan
- Department of Ophthalmology, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Nilufer Berker
- Ankara Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
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Bilateral acute depigmentation of the iris in two siblings simultaneously. Am J Ophthalmol Case Rep 2018; 10:257-260. [PMID: 29780946 PMCID: PMC5956750 DOI: 10.1016/j.ajoc.2018.03.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 02/28/2018] [Accepted: 03/15/2018] [Indexed: 12/17/2022] Open
Abstract
Purpose To report the first simultaneous onset of bilateral acute depigmentation of the iris (BADI) in two siblings. Observations Two sisters presented with bilateral ocular pain, redness and light sensitivity. Examination revealed bilateral circulating pigment in the anterior chamber with pigment dusting on backs of the corneas, patchy iris depigmentation and heavy pigment deposition in the angle. Both patients had recently suffered from upper respiratory tract infections. Bilateral visual acuities were preserved and no transillumination defects were observed. The patients were diagnosed with BADI. Both cases were successfully controlled with topical corticosteroids and anti-glaucoma drops as well as topical glanciclovir gel. Conclusions and Importance To date, there had been no published reports of BADI in the Middle East and Africa. This is the first observation of this entity in these regions. Moreover it is the first occurrence of BADI in two immediate siblings simultaneously. We also report the rare asymmetrical presentation with BADI in one of our patients. These observations point to the possibility of genetic factors underlying BADI as well as an infectious cause behind the etiology.
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Bilateral acute iris transillumination following systemic administration of antibiotics. Eye (Lond) 2018; 32:1190-1196. [PMID: 29497133 DOI: 10.1038/s41433-018-0054-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 01/14/2018] [Accepted: 01/29/2018] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To describe the demographic characteristics, clinical features, and potential prognostic factors of bilateral acute iris transillumination (BAIT) following oral antibiotic uptake. METHODS A retrospective study of 16 consecutive patients who developed BAIT following treatment with systemic antibiotics. Detailed past medical and ocular history was obtained, presenting signs and symptoms were documented and demographic characteristics were analyzed. All patients underwent a complete ocular examination and laboratory investigation. The course of best corrected visual acuity (BCVA), anterior chamber activity, and intraocular pressure (IOP) during the follow-up period were recorded and possible correlations with potential prognosticators were investigated. RESULTS Fourteen females and two males were included in the present study. The mean age (SD) of the patients was 43 (14) years. All individuals presented conjunctival injection and photophobia and developed bilateral transillumination defects, fixed mid-dilated pupils and pigment dispersion in the anterior chamber. Systemic antibiotics were previously prescribed in all cases (13 patients with moxifloxacin and three patients with clarithromycin) and the mean (SD) interval between onset of symptoms and antibiotic administration was 17 (4) days. Ocular hypertension complicated all eyes and required antiglaucoma medication in 25 eyes. Severe anterior chamber pigment dispersion and higher IOP during the first week after presentation was significantly associated with longer duration of ocular hypertension (OHT) (p = 0.019). CONCLUSIONS BAIT represents a rare clinical entity with characteristic features. Although etiopathogenesis of this condition remains unclear, a series of cases that indicate a strong correlation between systemic antibiotic administration and BAIT is herein presented.
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Den Beste KA, Okeke C. Trabeculotomy ab interno with Trabectome as surgical management for systemic fluoroquinolone-induced pigmentary glaucoma: A case report. Medicine (Baltimore) 2017; 96:e7936. [PMID: 29068979 PMCID: PMC5671812 DOI: 10.1097/md.0000000000007936] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
RATIONALE Bilateral acute iris transillumination (BAIT) is a poorly-understood ocular syndrome in which patients present with acute iridocyclitis and pigmentary dispersion with or without ocular hypertension. The etiology of the disease remains unknown, though recent reports suggest an antecedent upper respiratory tract infection or systemic antibiotic administration may trigger the clinical syndrome. PATIENT CONCERNS A 55-year-old female was referred for a second opinion regarding her bilateral ocular pain, photophobia, and ocular hypertension. Her medical history was notable for a diagnosis of pneumonia managed with oral moxifloxacin several weeks prior to her initial presentation. DIAGNOSES Visual acuity was 20/40 with an intraocular pressure (IOP) of 30 mmHg in the affected eye despite maximal tolerated medical therapy. The patient had severe bilateral iris transillumination defects with posterior synechiae formation and 3+ pigment with rare cell in the anterior chamber. This constellation of findings was consistent with a diagnosis of BAIT. INTERVENTIONS A peripheral iridotomy was placed, which mildly relieved the iris bowing, but did not affect the IOP or inflammatory reaction. The patient then underwent cataract extraction with posterior synechiolysis and ab interno trabeculotomy of the left eye with the Trabectome. OUTCOMES The patient's IOP on the first post-operative day was 13 mmHg, and anterior chamber inflammation was noted to be significantly reduced at post-operative week 2. The patient was recently seen at a 1-year post-operative visit and her IOP remains in the low teens on a low-dose combination topical agent. LESSONS Ophthalmologists should remain aware of the association between systemic fluoroquinolones and acute pigmentary dispersion that can progress to glaucoma. The Trabectome remains a viable option for management of pigmentary and uveitic glaucoma resistant to medical treatment.
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Affiliation(s)
| | - Constance Okeke
- Department of Ophthalmology, Eastern Virginia Medical School
- Virginia Eye Consultants, Norfolk, VA
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Rangel CM, Parra MM, Frederick G, Tello A, Varón CL. An unusual case of bilateral anterior uveitis related to moxifloxacin: the first report in Latin America. GMS OPHTHALMOLOGY CASES 2017; 7:Doc18. [PMID: 28706771 PMCID: PMC5506693 DOI: 10.3205/oc000069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective: To report a case of bilateral anterior uveitis secondary to oral moxifloxacin. Methods: Case report. Results: A 54-year-old female presented bilateral anterior uveitis following a 10-day course of oral moxifloxacin. She developed a bilateral anterior uveitis associated with pigment dispersion syndrome and iris transillumination. Conclusions: Drug-induced uveitis is one of the causes of anterior uveitis. Uveitis related to fluoroquinolones is a rare entity, there are few cases reported in the literature, this is the first case reported in Latin America.
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Affiliation(s)
- Carlos M Rangel
- Retina and Vitreous Department, Fundación Oftalmológica de Santander Clínica Carlos Ardila Lulle, Bucaramanga, Colombia
| | - M Margarita Parra
- Fundación Oftalmológica de Santander Clínica Carlos Ardila Lulle, Bucaramanga, Colombia
| | - Gabriel Frederick
- Fundación Oftalmológica de Santander Clínica Carlos Ardila Lulle, Bucaramanga, Colombia
| | - Alejandro Tello
- Anterior Segment and Refractive Surgery Department, Fundación Oftalmológica de Santander Clínica Carlos Ardila Lulle, Bucaramanga, Colombia
| | - Clara L Varón
- Retina and Vitreous Department, Fundación Oftalmológica de Santander Clínica Carlos Ardila Lulle, Bucaramanga, Colombia
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Mahanty S, Kawali AA, Dakappa SS, Mahendradas P, Kurian M, Kharbanda V, Shetty R, Setty SRG. Aqueous humor tyrosinase activity is indicative of iris melanocyte toxicity. Exp Eye Res 2017; 162:79-85. [PMID: 28712540 PMCID: PMC5563078 DOI: 10.1016/j.exer.2017.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 04/12/2017] [Accepted: 07/12/2017] [Indexed: 01/22/2023]
Abstract
Antibiotics such as fluoroquinolones (FQLs) are commonly used to treat ocular infections but are also known to cause dermal melanocyte toxicity. The release of dispersed pigments from the iris into the aqueous humor has been considered a possible ocular side effect of the systemic administration of FQLs such as Moxifloxacin, and this condition is known as bilateral acute iris transillumination (BAIT). Bilateral acute depigmentation of iris (BADI) is a similar condition, with iris pigment released into the aqueous, but it has not been reported as a side effect of FQL. Iris pigments are synthesized by the melanogenic enzyme tyrosinase (TYR) and can be detected but not quantified by using slit-lamp biomicroscopy. The correlation between dispersed pigments in the aqueous and the extent of melanocyte toxicity due to topical antibiotics in vivo is not well studied. Here, we aimed to study the effect of topical FQLs on iris tissue, the pigment release in the aqueous humor and the development of clinically evident iris atrophic changes. We evaluated this process by measuring the activity of TYR in the aqueous humor of 82 healthy eyes undergoing cataract surgery following topical application of FQLs such as Moxifloxacin (27 eyes, preservative-free) or Ciprofloxacin (29 eyes, with preservative) or the application of non-FQL Tobramycin (26 eyes, with preservative) as a control. In addition, the patients were questioned and examined for ocular side effects in pre- and post-operative periods. Our data showed a significantly higher mean TYR activity in the aqueous humor of Ciprofloxacin-treated eyes compared to Moxifloxacin- (preservative free, p < 0.0001) or Tobramycin-treated eyes (p < 0.0001), which indicated that few quinolones under certain conditions are toxic to the iris melanocytes. However, the reduced TYR activity in the aqueous of Moxifloxacin-treated eyes was possibly due to the presence of a higher drug concentration, which inhibits TYR activity. Consistently, immunoblotting analysis of the aqueous humor from both Ciprofloxacin- and Moxifloxacin-treated eyes showed the presence of soluble TYR enzyme, thus reflecting its toxicity to iris melanocytes and corresponding to its activity in the aqueous humor. Intriguingly, none of these patients developed any clinically appreciable ocular side effects characteristic of BAIT or BADI. Overall, our results suggest that topical antibiotics cause different levels of iris melanocyte toxicity, releasing dispersed pigments into the aqueous humor, which can be measured through TYR enzyme activity. Hence, we conclude that topical FQLs may cause subclinical toxicity to the iris melanocytes but may not be the sole cause of the development of BAIT or BADI.
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Affiliation(s)
- Sarmistha Mahanty
- Department of Microbiology and Cell Biology, Indian Institute of Science, Bangalore 560012, India
| | - Ankush A Kawali
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore 560010, India
| | - Shruthi Shirur Dakappa
- Department of Microbiology and Cell Biology, Indian Institute of Science, Bangalore 560012, India
| | | | - Mathew Kurian
- Department of Cataract, Narayana Nethralaya, Bangalore 560010, India
| | - Varun Kharbanda
- Department of Cataract, Narayana Nethralaya, Bangalore 560010, India
| | - Rohit Shetty
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore 560010, India
| | - Subba Rao Gangi Setty
- Department of Microbiology and Cell Biology, Indian Institute of Science, Bangalore 560012, India.
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Hinkle DM, Kruh-Garcia NA, Kruh JN, Broccardo C, Doctor P, Foster CS. Moxifloxacin Concentration and Proteomic Analysis of Aqueous Humor in Human Uveitis Associated with Oral Moxifloxacin Therapy. Open Ophthalmol J 2017; 11:107-116. [PMID: 28694894 PMCID: PMC5481612 DOI: 10.2174/1874364101711010107] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 12/08/2016] [Accepted: 04/02/2017] [Indexed: 11/22/2022] Open
Abstract
PURPOSE The aim was to report the aqueous humor moxifloxacin concentration and proteome profile of an individual with bilateral uveitis-like syndrome with pigment dispersion. METHODS Multiple reactions monitoring mass spectrometry quantified the aqueous concentration of moxifloxacin in the affected individual. Shotgun proteomic analysis performed via liquid chromatography tandem mass spectrometry (LC-MS/MS) defined the protein profile in the affected individual and unaffected control samples. RESULTS Moxifloxacin was present at higher than expected levels in aqueous humor 18 days following oral administration. One-third of the proteins were identified by significantly lower spectral counts in the aqueous of the individual with moxifloxacin associated uveitis compared to the unaffected control. CONCLUSION Moxifloxacin was detected in aqueous humor 18 days following the completion of oral administration. These results suggest that moxifloxacin toxicity may be responsible for the uveitis-like syndrome with pigment dispersion syndrome induced by moxifloxacin therapy.
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Affiliation(s)
- David M Hinkle
- Department of Ophthalmology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Nicole A Kruh-Garcia
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | | | - Carolyn Broccardo
- Research Integrity and Compliance Review Office, Colorado State University, Colorado, USA
| | - Priyanka Doctor
- Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts, USA
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts, USA
- Ocular Inflammation and Uveitis Foundation, Cambridge, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Abstract
IMPORTANCE Fluoroquinolones are the most commonly prescribed antibiotic class in the outpatient setting. Recent reports have implicated an association between oral fluoroquinolones and an increased risk of uveitis. OBJECTIVE To determine the hazard of uveitis with oral fluoroquinolone use. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study was conducted using medical claims data from a large national US insurer (N = 4,387,651). Cohorts from ambulatory care centers across the United States were created including every new user of an oral fluoroquinolone or β-lactam antibiotic prescription with at least 24 months of data prior to the date of the prescription from January 1, 2000, to January 30, 2013. Exclusion criteria consisted of any previous diagnosis of uveitis or a uveitis-associated systemic illness. Participants were censored for a new diagnosis of a uveitis-associated systemic illness, the end of an observation period, use of the other class of antibiotic, or removal from the insurance plan. Data analysis was performed from January 2 through March 15, 2015. MAIN OUTCOMES AND MEASURES The hazard of a uveitis diagnosis after a fluoroquinolone prescription compared with a β-lactam prescription using multivariate regression with Cox proportional hazards models. RESULTS Of the 4,387,651 patients in the database, 843,854 individuals receiving a fluoroquinolone and 3,543,797 patients receiving a β-lactam were included in the analysis. After controlling for age, race, and sex using multivariate analysis, no hazard for developing uveitis at the 30-, 60-, or 90-day observation windows was seen (hazard ratio [HR] range, 0.96; 95% CI, 0.82-1.13; to 1.05; 95% CI, 0.95-1.16; P > .38 for all comparisons). The 365-day observation period showed a small increase in the HR for the fluoroquinolone cohort (1.11; 95% CI, 1.05-1.17; P < .001). Moxifloxacin produced an increased hazard for uveitis at every time point (HR range, 1.47-1.75; 95% CI, 1.27-2.37; P < .001 for all comparisons). Secondary analysis demonstrated a similar hazard at 365 days for a later diagnosis of a uveitis-associated systemic illness after fluoroquinolone use (HR range, 1.46-1.96; 95% CI, 1.42-2.07; P < .001 for all comparisons). CONCLUSIONS AND RELEVANCE These data do not support an association between oral fluoroquinolone use and uveitis. Instead, this study shows an association between oral fluoroquinolone use and the risk for uveitis-associated systemic illnesses, which is a possible source of bias that could explain the findings of previous studies.
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Affiliation(s)
- Harpal Singh Sandhu
- Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Alexander J Brucker
- Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Liyuan Ma
- Leonard Davis Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Brian L VanderBeek
- Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia2Leonard Davis Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia3Center for Clinical Epidemiology and Bi
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Abstract
OBJECTIVE To evaluate the risk of developing glaucoma in patients taking systemic fluoroquinolones. METHODS A case-control study was carried out among a cohort of subjects who had visited an ophthalmologist in the Province of British Columbia, Canada from 2000 to 2007. Cases were identified as those newly diagnosed with glaucoma (ICD-9 360). For each case, 5 controls were selected and matched to the cases by age and calendar time. Crude and adjusted rate ratios (RRs) for current, recent, past, and distant use of fluoroquinolones were calculated. RESULTS From the cohort of 989,591 subjects, 178,264 subjects were diagnosed with glaucoma and 891,320 were corresponding controls. The 2 groups had same average age of 65 and comparable systemic comorbidities including hypertension, coronary artery disease, and diabetes. There was no statistically significant association between the use of systemic fluoroquinolones and the development of glaucoma for current use [RR=1.01 (95% confidence interval (CI), 0.95-1.07)], recent use [RR=1.00 (95% CI, 0.92-1.08)], or past use [RR=0.94 (95% CI, 0.90-1.00)]. Distant use of systemic fluoroquinolones had a small statistically significant increased risk of developing glaucoma [RR=1.12 (95% CI, 1.09-1.14)]. CONCLUSIONS There was no detected increased association of the development of glaucoma with current, recent, or past use of systemic fluoroquinolone but a minimal statistically significant increased risk was associated with distant use. Future studies should further examine a potential delayed response with fluoroquinolones and glaucoma.
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Abstract
INTRODUCTION Drug-induced uveitis is a well described but often overlooked and/or misdiagnosed adverse reaction to medication. There are an increasing number of medications that have been related to the onset of intraocular inflammation. Identification of these inciting agents may decisively help the diagnostic algorithm involving new cases of uveitis. AREAS COVERED This review intends to be an updated comprehensive, practical guide for practitioners regarding the main drugs that have been associated with uveitis. A classification proposed by Naranjo et al. in 1981 for establishing potential causality is applied examining possible mechanisms of action. A guide for clinicians about the rationale of these observations when dealing with patients with uveitis is provided. EXPERT OPINION Several agents with different routes of administration (systemic, topical and/or intraocular) may cause intraocular inflammation. The mechanism behind ocular inflammation is frequently unknown. Clinicians should be aware of the potential drug effect to optimize diagnosis and management of such patients.
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Affiliation(s)
- Miguel Cordero-Coma
- Department of Ophthalmology, University Hospital of León , León , Spain +34 987237400 ; +34 987233322 ;
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Arunvikram K, Mohanty I, Sardar KK, Palai S, Sahoo G, Patra RC. Adverse drug reaction and toxicity caused by commonly used antimicrobials in canine practice. Vet World 2014. [DOI: 10.14202/vetworld.2014.299-305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Gonul S, Bozkurt B, Okudan S, Tugal-Tutkun I. Bilateral acute iris transillumination following a fumigation therapy: a village-based traditional method for the treatment of ophthalmomyiasis. Cutan Ocul Toxicol 2014; 34:80-3. [DOI: 10.3109/15569527.2014.886589] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kapoor KG, Hodge DO, St Sauver JL, Barkmeier AJ. Oral fluoroquinolones and the incidence of rhegmatogenous retinal detachment and symptomatic retinal breaks: a population-based study. Ophthalmology 2014; 121:1269-73. [PMID: 24480710 DOI: 10.1016/j.ophtha.2013.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 11/25/2013] [Accepted: 12/04/2013] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To examine whether oral fluoroquinolone antibiotics are associated with an increase in subsequent rhegmatogenous retinal detachment and symptomatic retinal breaks in a large population-based cohort. DESIGN Population-based cohort study. PARTICIPANTS AND CONTROLS Adult residents of Olmsted County, Minnesota, who were prescribed oral fluoroquinolone medications from January 1, 2003, to June 30, 2011. Comparison cohorts consisted of patients prescribed oral macrolide and β-lactam antibiotics during the study period. METHODS Procedure codes were used to identify retinal detachment repair and prophylaxis procedures occurring within 1 year of prescription dates. Travel clinic, pro re nata, and self-treatment prescriptions were excluded. Patients with tractional retinal detachment, previous retinal detachment repair, endophthalmitis, and necrotizing retinitis were excluded, as were those with intraocular surgery or severe head/eye trauma ≤90 days before the procedure. MAIN OUTCOME MEASURES Rates of retinal detachment repair and prophylaxis procedures within 7, 30, 90, and 365 days of the first prescription were calculated and compared between antibiotic prescription cohorts using chi-square tests. Retinal detachment repair rates also were compared with the expected Olmsted County, Minnesota, rates using the one-sample log-rank test. RESULTS Oral fluoroquinolones were prescribed for 38,046 patients (macrolide n = 48,074, β-lactam n = 69,079) during the study period. Retinal detachment repair procedures were performed within 365 days of the first prescription in 0.03% (95% confidence interval [CI], 0.01-0.06) of the fluoroquinolone cohort, 0.02% (95% CI, 0.01-0.03) of the macrolide cohort, and 0.03% (95% CI, 0.02-0.05) of the β-lactam cohort (P > 0.05). Retinal detachment prophylaxis procedures for symptomatic retinal breaks were performed within 365 days of the first prescription in 0.01% (95% CI, 0.00-0.03) of the fluoroquinolone cohort, 0.02% (95% CI, 0.01-0.04) of the macrolide cohort, and 0.02% (95% CI, 0.01-0.04) of the β-lactam cohort (P > 0.05). Similar comparisons of treatment rates within 7, 30, and 90 days of the first prescription were all nonsignificant between cohorts. Post-fluoroquinolone retinal detachment repair rates were similar to expected rates (36.8 per 100,000/year vs. 28.8 per 100,000/year for age- and sex-matched historical rates, P = 0.35). CONCLUSIONS Oral fluoroquinolone use was not associated with an increased risk of rhegmatogenous retinal detachment or symptomatic retinal breaks in this population-based study.
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Affiliation(s)
- Kapil G Kapoor
- Mayo Clinic Department of Ophthalmology, Rochester, Minnesota
| | - David O Hodge
- Mayo Clinic Department of Health Sciences Research, Rochester, Minnesota
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Forooghian F, Maberley D, Albiani DA, Kirker AW, Merkur AB, Etminan M. Uveitis risk following oral fluoroquinolone therapy: a nested case-control Study. Ocul Immunol Inflamm 2013; 21:390-3. [PMID: 23876164 DOI: 10.3109/09273948.2013.808351] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine the risk of uveitis associated with the use of oral fluoroquinolones. METHODS Nested case-control study of all patients who visited an ophthalmologist in British Columbia, Canada, between 2000 and 2007, as captured in the British Columbia Health Linked Database. RESULTS A total 3383 incident cases of uveitis and 33,830 corresponding controls were identified. Among patients who had used oral fluoroquinolones within the past 30 days, the adjusted relative risk of uveitis was 3.53 (95% CI, 2.84-4.39). However, the relative risk of uveitis among patients taking oral macrolides and beta-lactams was also significantly elevated. CONCLUSIONS Our data do not provide convincing evidence of an association between fluoroquinolones and uveitis, as this study found an association between several classes of antibiotics and uveitis. It is possible that the systemic processes for which these antibiotics are being prescribed are in fact the inciting factors for the uveitis.
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Affiliation(s)
- Farzin Forooghian
- Department of Ophthalmology & Visual Sciences, University of British Columbia , Vancouver, British Columbia , Canada
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Kedhar SR. Research in Uveitis and Ocular Inflammation, 2011 to 2012. ASIA-PACIFIC JOURNAL OF OPHTHALMOLOGY (PHILADELPHIA, PA.) 2013; 2:187-98. [PMID: 26108112 DOI: 10.1097/apo.0b013e3182950d58] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This study was aimed to provide ophthalmologists with an update of recent research and developments in the areas of ocular immunology and uveitis. DESIGN This is a literature review. METHODS A 1-year search (July 1, 2011, to June 30, 2012) of the English language literature on PubMed was conducted using the search terms ocular immunology, ocular inflammation, uveitis, iritis, iridocyclitis, intermediate uveitis, posterior uveitis, panuveitis, pediatric uveitis, scleritis, choroiditis, retinitis, uveitic glaucoma, uveitic cataract, hypotony, immunomodulators, immunosuppressive therapy, corticosteroids, drug-induced uveitis, sarcoidosis, toxoplasmosis, tuberculosis, syphilis, herpes simplex virus, herpes zoster virus, cytomegalovirus, optical coherence tomography, mucous membrane pemphigoid, experimental autoimmune uveitis, and endotoxin-induced uveitis. Approximately 10% of articles studied were included in this article. RESULTS This review incorporates original articles encompassing new insights and updates to the field of uveitis and ocular immunology. Particular consideration was given to randomized, controlled clinical trials as well as analyses of larger cohorts; however, smaller studies and case reports involving new aspects of treatment/diagnosis or expanding the understanding of disease processes were also included. CONCLUSIONS Review of the literature reflected an improved understanding of uveitic disease and treatments, especially in the areas of immunomodulatory therapy, uveitic cystoid macular edema, toxoplasmosis, and sarcoidosis. Results from the Systemic Immunosuppressive Therapy for Eye Diseases Study and the Multicenter Uveitis Steroid Treatment trial, especially, yielded useful information in a number of areas. By its nature, this review cannot be all inclusive but is meant to focus on the literature and results most relevant to ophthalmologists in practice.
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London NJS, Garg SJ, Moorthy RS, Cunningham ET. Drug-induced uveitis. J Ophthalmic Inflamm Infect 2013; 3:43. [PMID: 23522744 PMCID: PMC3637087 DOI: 10.1186/1869-5760-3-43] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 03/13/2013] [Indexed: 01/21/2023] Open
Abstract
A number of medications have been associated with uveitis. This review highlights both well-established and recently reported systemic, topical, intraocular, and vaccine-associated causes of drug-induced uveitis, and assigns a quantitative score to each medication based upon criteria originally described by Naranjo and associates.
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Affiliation(s)
- Nikolas JS London
- Retina Consultants San Diego, 9850 Genesee Avenue, Suite 700, La Jolla, CA, 92037, USA
| | - Sunir J Garg
- MidAtlantic Retina, The Retina Service of Wills Eye Institute, Thomas Jefferson University, 840 Walnut Street, Suite 1020, Philadelphia, PA, 19107, USA
| | - Ramana S Moorthy
- Associated Vitreoretinal and Uveitis Consultants, St. Vincent Hospital and Health Services, Indianapolis, IN, 46260, USA
- Associate Clinical Professor of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Emmett T Cunningham
- Department of Ophthalmology, California Pacific Medical Center, San Francisco, CA, 94115, USA
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, 94305-5101, USA
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Duncombe A, Gueudry J, Massy N, Chapuzet C, Gueit I, Muraine M. Pseudo-uvéite sévère associée à l’utilisation de moxifloxacine. J Fr Ophtalmol 2013. [DOI: 10.1016/j.jfo.2012.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Knape RM, Sayyad FE, Davis JL. Moxifloxacin and bilateral acute iris transillumination. J Ophthalmic Inflamm Infect 2013; 3:10. [PMID: 23514193 PMCID: PMC3605082 DOI: 10.1186/1869-5760-3-10] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 09/12/2012] [Indexed: 11/10/2022] Open
Abstract
Recent publications have alerted clinicians to a syndrome of uveitic transilluminating iris depigmentation associated with systemic fluoroquinolones and other antibiotics. Bilateral acute iris transillumination, which is associated with loss of the iris pigment epithelium and results in iris transillumination, differs from the previously described bilateral acute depigmentation of the iris, which is associated with atrophy of the iris stroma without transillumination. We present a case of fluoroquinolone-associated uveitis with anterior segment optical coherence tomography imaging to highlight some observations about this syndrome. We interpret pharmacokinetic data to help explain why oral, but not topical, moxifloxacin may cause fluoroquinolone-associated uveitis.
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Affiliation(s)
- Robert M Knape
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 N,W, 17th St, Miami, FL 33136, USA.
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