Den Beste Kyle A, Okeke Constance
Department of Ophthalmology, Eastern Virginia Medical School Virginia Eye Consultants, Norfolk, VA.
Medicine (Baltimore). 2017 Oct;96(43):e7936. doi: 10.1097/MD.0000000000007936.
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.
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.
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.
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.
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.
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.
双侧急性虹膜透照缺损（BAIT）是一种了解较少的眼部综合征，患者表现为急性虹膜睫状体炎和色素播散，伴或不伴有高眼压。尽管最近的报告表明，先前的上呼吸道感染或全身使用抗生素可能引发该临床综合征，但该病的病因仍不明。
一名55岁女性因双侧眼痛、畏光和高眼压前来寻求第二种意见。她的病史值得注意的是，在初次就诊前几周，她因肺炎接受口服莫西沙星治疗。
尽管接受了最大耐受的药物治疗，但患眼视力为20/40，眼压（IOP）为30 mmHg。患者双侧虹膜透照缺损严重，伴有后粘连形成，前房有3+色素，偶见细胞。这一系列表现符合BAIT的诊断。
进行了周边虹膜切开术，这轻度缓解了虹膜膨隆，但未影响眼压或炎症反应。然后患者接受了白内障摘除术，同时进行了后粘连松解术，并使用Trabectome对左眼进行了内路小梁切开术。
术后第一天患者的眼压为13 mmHg，术后第2周前房炎症明显减轻。患者最近在术后1年就诊时，使用低剂量联合局部用药，眼压仍维持在十几的低值。
眼科医生应始终意识到全身氟喹诺酮类药物与可进展为青光眼的急性色素播散之间的关联。对于药物治疗无效的色素性和葡萄膜炎性青光眼，Trabectome仍然是一种可行的治疗选择。
