Bilateral Acute Iris Transillumination Associated to Moxifloxacin/Antibiotic Use

Abstract

Purpose : Bilateral acute iris transillumination (BAIT) is characterized by conjunctival injection and photophobia, with clinical findings of bilateral severe iris transillumination, pupils that are fixed and mid-dilated, and anterior chamber pigment dispersion. BAIT has a documented association with antibiotic use, in particular systemic moxifloxacin. The data regarding predisposing factors and demographic characteristics in the Latino population is limited. Our retrospective study aims to report the clinical and demographic characteristics and identify risk factors leading to BAIT in our population.

Methods : A retrospective review of patients diagnosed with BAIT was performed in two private ophthalmology practices in San Juan, Puerto Rico. All the patients were personally examined by either of two uveitis specialists who established the BAIT diagnosis. Prior to the diagnosis, all patients underwent an extensive systemic workup to rule out other possible etiologies such as HSV, syphilis, tuberculosis, and sarcoidosis; no evidence of these or other systemic conditions to explain the diagnosis of BAIT was found.

Results : A total of 72 eyes of 36 patients with BAIT were identified. The total antibiotic use within our BAIT cohort was 83%, of which 66% reported the use of moxifloxacin. The median age at presentation was 53 years; 80% of the patients were female. The most common systemic conditions were hypertension (31%) and chronic obstructive pulmonary disease (17%). Seventy-two percent of eyes had a best-corrected visual acuity greater than or equal to 20/50. At presentation, the median intraocular pressure (IOP) was 18 mmHg (range 8-50); 20 eyes (27%) had IOP greater than 21 mmHg, and 18 had IOP greater than or equal to 30 mm Hg. Anterior uveitis and pigmented cells in the anterior chamber, both observed in 38% of eyes, were the most prevalent associated ocular findings. Transillumination was diffuse in 59% of patients, and 63% also had pupillary sphincter atrophy.

Conclusions : As reported in prior studies, within our cohort, BAIT was more common in women, and the most common antibiotic predisposing to BAIT was moxifloxacin. To our knowledge, this is the first retrospective epidemiologic study of BAIT in the Puerto Rican population.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.