Título

BILATERAL ACUTE IRIS TRANSILUMINATION (BAIT) AND BILATERAL ACUTE IRIS DEPIGMENTATION (BADI) AFTER PHOTOREFRACTIVE KERATECTOMY (PRK)

Objetivo

Describe a case of bilateral acute depigmentation of the iris (BADI) and bilateral acute iris transillumination (BAIT) after Photorefractive Keratectomy (PRK)

Relato do Caso

ALSCM, 33 years old, was referred to HORP's glaucoma department due to increased intraocular pressure 20 days after a Photorefractive Keratectomy (PRK). He reports being using moxiflocacin 5MG/ML and dexanethasone 1mg/ml, initially every 4 hours, for a week every 2 hours. On examination, intraocular pressure was 21mmHg in the right eye (OD) and 20mmHg in the left eye (OS). Uncorrected visual acuity of 20/60 (0.30) and 20/30 (0.667). In slip lamp, it was noticed pigment dispersion in the corneal endothelium and diffuse iris atrophy and positive transillumination. Clinical treatment was initiated with prednisolone 10MG/ML every 6 hours, tapering every week, and combined brimonidine 2MG/ML and Timolol 6.8MG/ML every 12 hours. The antibiotic was discontinued. Pigment dispersion caused crises of pressure oscillation, requiring acetazolamide 250 mg every 12 hrs. After 6 weeks under treatment the patient's clinical condition improved, maintaining intraocular pressure of 12 mmHg and 16 mmHg, uncorrected visual acuity of 20/30 (0.667) in OD and 20/20 (1.0) in OS, without hypotensive eye drops.

Conclusão

First described in mid-2000s, bilateral acute depigmentation of the iris (BADI) and bilateral acute iris transillumination (BAIT) are likely on the same spectrum with the former describing acute onset depigmentation of the iris without transillumination or pupillary sphincter defects. Systemic antimicrobials, particularly moxifloxacin, but also clarithromycin and fumagilin therapy, have been prescribed. Of the fluoroquinolones, moxifloxacin had the highest risk for uveitis, followed by ciprofloxacin. Interestingly, sensitivity to fluoroquinolone toxicity has been associated with HLA-B51 and HLA-B27 positivity in 40% and 20% of affected patients, respectively, in one study suggesting an underlying autoimmune aspect.