Kalogera Efthymia, Spanos Evangelos, Karampelas Michael, Halkiadakis Ioannis, Peponis Vasileios, Konstantopoulou Kallirroi
A' Ophthalmology Department, Specialized Eye Hospital Ophthalmiatreio Athinon, Sina 2, 106 72, Athens, Greece.
Sismanoglio General Hospital, Sismanogliou 1, 151 26, Athens, Greece.
Ophthalmol Ther. 2025 May;14(5):1157-1168. doi: 10.1007/s40123-025-01135-w. Epub 2025 Apr 2.
Bilateral acute iris transillumination (BAIT) is a recently described entity, usually following moxifloxacin intake or respiratory tract infections. Interest in the disease has increased since the COVID-19 pandemic; however, its etiopathogenesis remains unclear. This study presents five cases in Greece with symptoms and signs suggestive of BAIT after systemic moxifloxacin administration. Unusual clinical manifestations and differential diagnosis are highlighted.
Five female patients presented to the Uveitis Department complaining of bilateral photophobia and redness following systemic moxifloxacin intake. Past ocular history was unremarkable. The median best corrected visual acuity (BCVA) was 7/10 (range 4/10-9/10) and mean intraocular pressure (IOP) was 17 mmHg, with one eye demonstrating increased IOP of 32 mmHg. Clinical findings included bilateral diffuse mid-peripheral iris transillumination, conjunctival hyperemia, unresponsive pupils, and pigment dispersion into the anterior chamber. Two cases presented blue-colored irides. Gonioscopy showed pigment deposition at the trabecular meshwork. Anterior segment optical coherence tomography (OCT) revealed a normal iris configuration in all cases.
In Greece, BAIT has been infrequently described, with the highest prevalence being reported in Türkiye. The etiopathogenesis remains unknown, but the typical geographical distribution raises suspicion of a genetic predisposition. BAIT could be considered a drug-related adverse event or an ocular manifestation of viral infections, such as COVID-19. Clinical findings may vary, though differential diagnosis can be quite challenging. In cases with elevated intraocular pressure, topical treatment is usually adequate, although surgical approaches have been reported in the literature. All of our cases fit the clinical features of BAIT. Interestingly, two of the patients had light blue iris color.
Understanding the clinical manifestations of the disease and its geographic spread facilitates a prompt clinical diagnosis, preventing unnecessary diagnostic tests. Although BCVA is typically well preserved in BAIT, persistent photophobia may lead to severe visual impairment. Further research is necessary to elucidate the exact etiopathogenesis of BAIT and explore genetic factors that may predispose individuals to this condition.
双侧急性虹膜透照（BAIT）是一种最近才被描述的病症，通常在服用莫西沙星或呼吸道感染后出现。自新冠疫情以来，人们对该疾病的关注度有所增加；然而，其病因发病机制仍不清楚。本研究报告了希腊的5例在全身使用莫西沙星后出现提示BAIT症状和体征的病例。文中强调了不寻常的临床表现和鉴别诊断。
5名女性患者因全身服用莫西沙星后出现双侧畏光和眼红症状就诊于葡萄膜炎科。既往眼部病史无异常。最佳矫正视力（BCVA）中位数为7/10（范围4/10 - 9/10），平均眼压（IOP）为17 mmHg，其中一只眼眼压升高至32 mmHg。临床检查发现包括双侧弥漫性中周边虹膜透照、结膜充血、瞳孔无反应以及色素播散至前房。2例患者出现蓝色虹膜。前房角镜检查显示小梁网有色素沉着。前段光学相干断层扫描（OCT）在所有病例中均显示虹膜结构正常。
在希腊，BAIT鲜有报道，土耳其报告的患病率最高。病因发病机制仍然未知，但典型的地理分布引发了对遗传易感性的怀疑。BAIT可被视为药物相关不良事件或病毒感染（如新冠病毒）的眼部表现。临床表现可能有所不同，尽管鉴别诊断颇具挑战性。对于眼压升高的病例，局部治疗通常足够，尽管文献中也报道了手术治疗方法。我们所有的病例均符合BAIT的临床特征。有趣的是，其中两名患者虹膜颜色为浅蓝色。
了解该疾病的临床表现及其地理分布有助于及时进行临床诊断，避免不必要的诊断检查。虽然在BAIT中BCVA通常保存良好，但持续畏光可能导致严重视力损害。有必要进一步研究以阐明BAIT的确切病因发病机制，并探索可能使个体易患该病的遗传因素。
