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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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Gonzalez Martinez OG, Shields CL, Shields JA, Chévez-Barrios P, Walley DR, Eagle RC, Milman T. Unilateral acute iris transillumination syndrome with glaucoma and iris pigment epithelium dispersion simulating iris melanoma. Am J Ophthalmol Case Rep 2023; 32:101912. [PMID: 37680309 PMCID: PMC10481171 DOI: 10.1016/j.ajoc.2023.101912] [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: 05/25/2023] [Revised: 07/23/2023] [Accepted: 08/11/2023] [Indexed: 09/09/2023] Open
Abstract
Purpose To report a patient with a unilateral presentation of glaucoma, pain, and acute iris transillumination syndrome simulating iris melanoma. Observations A 53-year-old male presented with blurred vision and pain in his right eye several weeks following a respiratory sinus infection managed by oral azithromycin. Examination of the right eye was notable for elevated intraocular pressure of 46 mm Hg, an irregular mid-dilated pupil, and diffuse iris transillumination with pigmentary seeding on the iris surface, in the anterior chamber angle, and on the sclera, suspicious for diffuse iris melanoma with glaucoma and extrascleral extension. Ultrasound biomicroscopy (UBM) of the right eye revealed circumferential anterior chamber angle and trabecular meshwork involvement by an infiltrative process corresponding to the pigmented cells noted clinically, while the ciliary body was unremarkable. Following enucleation, histopathology showed extensive necrosis of the iris pigment epithelium, sphincter, and dilator muscles with melanophagic infiltration in the anterior chamber angle and episclera, mild chronic non-granulomatous iridocyclitis, and no evidence of a melanocytic neoplasm. Although immunohistochemical studies for herpes simplex virus (HSV) types 1 and 2, varicella-zoster virus, and cytomegalovirus were negative, qualitative real-time polymerase chain reaction on paraffin-embedded tissue detected HSV-1 DNA. The combined clinical, pathologic, and molecular findings were compatible with unilateral acute iris transillumination syndrome, likely HSV-1 associated. Conclusion and Importance Unilateral acute iris transillumination syndrome with diffuse iris pigment epithelial loss can simulate iris melanoma. Prompt herpes viral studies may be informative.
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Affiliation(s)
- Orlando G. Gonzalez Martinez
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Carol L. Shields
- Department of Ocular Oncology Service, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
- Department of Ophthalmology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Jerry A. Shields
- Department of Ocular Oncology Service, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
- Department of Ophthalmology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Patricia Chévez-Barrios
- Department of Pathology and Laboratory Medicine and Ophthalmology, Weill Cornell Medical College, NY, USA
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TXs, USA
| | - Debbie Rigney Walley
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TXs, USA
| | - Ralph C. Eagle
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
- Department of Ophthalmology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Tatyana Milman
- Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
- Department of Ophthalmology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
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Gonul S, Eker S. Unilateral Acute Iris Transillumination Syndrome following Uneventful Phacoemulsification Surgery with Intracameral Moxifloxacin. Ocul Immunol Inflamm 2022; 30:1984-1987. [PMID: 34003710 DOI: 10.1080/09273948.2021.1916042] [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: 12/16/2022]
Abstract
PURPOSE We report a case of unilateral acute iris transillumination (AIT) and iris sphincter paralysis in a 63-year-old male undergone uneventful phacoemulsification surgery with intracameral moxifloxacin (ICM). CASE PRESENTATION This is a case of AIT with no history of viral disease or use of systemic fluoroquinolone but an association with ICM after uneventful phacoemulsification. The clinical features of the affected eye are perfectly similar to what has been described in BAIT and hence we consider that unilateral AIT and BAIT share the same etiopathogenesis. At the end of the phacoemulsification, the patient received 0.15 ml of 5mg/ml moxifloxacin, which is notably higher than the dose that is commonly used for ICM. This may have caused the patient to develop BAIT-like syndrome after the ICM. CONCLUSION 0.1 ml of 5mg/ml moxifloxacin or less should be used to reduce the risk of occurrences of this toxic effect caused by ICM.
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Affiliation(s)
- Saban Gonul
- Department of Ophthalmology, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Serhat Eker
- Department of Ophthalmology, Selcuk University Faculty of Medicine, Konya, Turkey
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Gonul S, Eker S. Comments On: Grzybowski et al: Commonly used intracameral antibiotics for endophthalmitis prophylaxis: A literature review. Surv Ophthalmol 2021; 66:902-904. [PMID: 33610584 DOI: 10.1016/j.survophthal.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 02/15/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Saban Gonul
- Selçuk University Faculty of Medicine, Konya, Turkey.
| | - Serhat Eker
- Selçuk University Faculty of Medicine, Konya, Turkey
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Gonul S, Bakbak B. Anterior Uveitis Due to Intracameral Moxifloxacin: A Case Report. Ocul Immunol Inflamm 2020; 30:244-245. [DOI: 10.1080/09273948.2020.1797118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Saban Gonul
- Department of Ophthalmology, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Berker Bakbak
- Department of Ophthalmology, Selcuk University Faculty of Medicine, Konya, Turkey
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Singh S, Diwan S, Sachdev MS. Bilateral acute depigmentation of the iris in a child following exposure to insecticide spray. Indian J Ophthalmol 2020; 68:1191-1193. [PMID: 32461477 PMCID: PMC7508121 DOI: 10.4103/ijo.ijo_1676_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Bilateral acute depigmentation of the iris (BADI) is a rare disease of unkown etiology. We report a case of BADI in a 10-year-old child after accidental exposure to a herbal insecticide. Spontaneous iris repigmentation was observed during the follow-up period.
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Affiliation(s)
- Swati Singh
- Anterior Segment, Cataract and Glaucoma Services, Centre for Sight Eye Hospital, New Delhi, India
| | - Shilpi Diwan
- Anterior Segment, Cornea and Refractive Surgery, Centre for Sight Eye Hospital, New Delhi, India
| | - Mahipal Singh Sachdev
- Cataract, Anterior Segment, Cornea and Refractive Surgery, Centre for Sight Eye Hospital, New Delhi, India
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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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Perone JM, Reynders S, Sujet-Perone N, Yahia R, Neiter E, Krawczyk P, Tortuyaux F, Sot M, Lhuillier L. [Bilateral acute iris transillumination syndrome: Case report]. J Fr Ophtalmol 2017; 40:713-716. [PMID: 28869039 DOI: 10.1016/j.jfo.2017.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 01/27/2017] [Indexed: 11/26/2022]
Affiliation(s)
- J M Perone
- Département d'ophtalmologie, CHR Metz-Thionville, Mercy Hospital, 1, allée du Château, CS 45001, 57085 Metz cedex 03, France.
| | - S Reynders
- Oogcentrum oostende, Vlierstraat 22, 8400 Oostende, Belgique
| | - N Sujet-Perone
- Département d'ophtalmologie, CHR Metz-Thionville, Mercy Hospital, 1, allée du Château, CS 45001, 57085 Metz cedex 03, France
| | - R Yahia
- Département d'ophtalmologie, CHR Metz-Thionville, Mercy Hospital, 1, allée du Château, CS 45001, 57085 Metz cedex 03, France
| | - E Neiter
- Département d'ophtalmologie, CHR Metz-Thionville, Mercy Hospital, 1, allée du Château, CS 45001, 57085 Metz cedex 03, France
| | - P Krawczyk
- Département d'ophtalmologie, CHR Metz-Thionville, Mercy Hospital, 1, allée du Château, CS 45001, 57085 Metz cedex 03, France
| | - F Tortuyaux
- Département d'ophtalmologie, CHR Metz-Thionville, Mercy Hospital, 1, allée du Château, CS 45001, 57085 Metz cedex 03, France
| | - M Sot
- Département d'ophtalmologie, CHR Metz-Thionville, Mercy Hospital, 1, allée du Château, CS 45001, 57085 Metz cedex 03, France
| | - L Lhuillier
- Département d'ophtalmologie, CHR Metz-Thionville, Mercy Hospital, 1, allée du Château, CS 45001, 57085 Metz cedex 03, France
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Bilateral acute iris transillumination: Case report. Saudi J Ophthalmol 2016; 30:122-4. [PMID: 27330389 PMCID: PMC4908095 DOI: 10.1016/j.sjopt.2015.11.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 09/18/2015] [Accepted: 11/28/2015] [Indexed: 11/24/2022] Open
Abstract
Bilateral acute iris transillumination (BAIT) is a recently defined disease characterized with bilateral acute, severe pigment dispersion of iris and pupil sphincter paralysis. The etiopathogenesis of the disease is unknown, but antibiotics such as moxifloxacin, clarithromycin, viral infections, and fumigation therapies were considered as probable etiologic factors. A 33-year-old female was referred to our clinic for acute iridocyclitis refractory to azathioprine, colchicum and corticosteroid treatments. Ophthalmic examination revealed bilateral pigment dispersion, significant iris transillumination, heavy pigment deposition in iridocorneal angle, and elevated intraocular pressure. Upon systemic evaluation she was found to have bacterial urinary tract infection. BAIT is an important cause of pigment dispersion and clinicians must be vigilant for this condition to avoid unnecessary diagnostic tests and treatment.
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