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Unilateral Iris Transillumination Resembling BAIT Phenotype Following Contralateral Vitrectomy
Olivier Lambrechts1, Luc Van Os1
1Ophthalmology, University Hospital Antwerp, Edegem, Belgium.
Insights
This case study reports the first unilateral presentation of acute iris transillumination (BAIT) after contralateral vitrectomy. It suggests prior treatments may offer protection against developing BAIT syndrome.
Area of Science:
- Ophthalmology
- Retinal Surgery
- Uveitis
Background:
- Acute iris transillumination (BAIT) syndrome is a rare condition.
- Vitrectomy is a common surgical procedure for retinal diseases.
- Postoperative endophthalmitis is a serious complication of ocular surgery.
Observation:
- A 70-year-old female developed unilateral BAIT in her left eye after undergoing vitrectomy and treatment for endophthalmitis in her right eye.
- The right eye, which had the initial surgery and endophthalmitis, did not develop BAIT.
- The patient received various treatments including topical corticosteroids, antibiotics, and intravitreal vancomycin.
Findings:
- This is the first reported case of a unilateral BAIT phenotype following contralateral vitrectomy.
- The affected eye showed patchy iris transillumination.
- The contralateral eye remained unaffected.
Implications:
- Previous vitrectomy may confer a protective effect against developing BAIT.
- Specific medications like vancomycin, topical corticosteroids, or chloramphenicol might play a role in preventing BAIT.
- Further research is needed to understand the mechanisms behind unilateral BAIT and potential protective factors.
Abstract:
Objective: This study is aimed at describing a unilateral presentation of acute iris transillumination following contralateral vitrectomy with postoperative endophthalmitis. Methods: This case study is based on the medical record of a patient who presented to our hospital in 2017. Results: 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. Conclusion: 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.
