Lambrechts Olivier, Van Os Luc
Ophthalmology, University Hospital Antwerp, Edegem, Belgium.
Case Rep Ophthalmol Med. 2025 Mar 5;2025:6612262. doi: 10.1155/crop/6612262. eCollection 2025.
This study is aimed at describing a unilateral presentation of acute iris transillumination following contralateral vitrectomy with postoperative endophthalmitis. This case study is based on the medical record of a patient who presented to our hospital in 2017. A 70-year-old female patient presented to our department with metamorphopsia and decreased vision in the right eye. She was diagnosed with a Stage 3 macular hole in the right eye for which she underwent 23G pars plana vitrectomy with gas tamponade. Postoperative topical treatment of tobramycin/dexamethasone was administered. Nine days after surgery, she presented to a different medical center with postoperative endophthalmitis in the right eye. Oral moxifloxacin was administered, an intravitreal injection with vancomycin was performed, and topical treatment with dexamethasone/chloramphenicol and neomycin/polymyxin B/dexamethasone was started. One month after surgery, she presented again to our department, this time with scleritis with associated anterior uveitis of the left eye. She was treated with oral ibuprofen, topical prednisolone acetate, and atropine sulfate, which resulted in clinical resolution. Three weeks after this episode, the left eye showed patchy transillumination of the iris matching the bilateral acute iris transillumination (BAIT) syndrome phenotype; however, the iris in the right eye remained normal. To the best of our knowledge, this case is the first to show a unilateral phenotype of BAIT after contralateral vitrectomy. This suggests that previous vitrectomy, injection of vancomycin, or topical corticosteroids or chloramphenicol could be protective against the development of acute iris transillumination.
本研究旨在描述对侧玻璃体切除术后发生术后眼内炎时急性虹膜透照缺损的单侧表现。本病例研究基于2017年就诊于我院的一名患者的病历。一名70岁女性患者因视物变形和右眼视力下降就诊于我科。她被诊断为右眼3期黄斑裂孔，为此接受了23G玻璃体切割联合气体填充术。术后给予妥布霉素/地塞米松局部治疗。术后9天，她因右眼术后眼内炎就诊于另一家医疗中心。给予口服莫西沙星，行玻璃体腔注射万古霉素，并开始使用地塞米松/氯霉素和新霉素/多粘菌素B/地塞米松局部治疗。术后1个月，她再次就诊于我科，此次是左眼巩膜炎伴前葡萄膜炎。给予口服布洛芬、局部用醋酸泼尼松龙和硫酸阿托品治疗，临床症状缓解。此次发作3周后，左眼出现与双侧急性虹膜透照缺损（BAIT）综合征表型相符的虹膜斑片状透照缺损；然而，右眼虹膜仍正常。据我们所知，该病例是首例对侧玻璃体切除术后出现BAIT单侧表型的病例。这表明既往玻璃体切除术、万古霉素注射或局部使用皮质类固醇或氯霉素可能对急性虹膜透照缺损的发生具有保护作用。
