Secondary glaucoma induced by bilateral acute depigmentation of the iris

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Abstract

Abstract We report a case of a middle-aged woman who developed acute, bilateral, symmetrical, slightly transilluminating depigmentation of the iris and pigment discharge into the anterior chamber following the use of oral moxifloxacin for bacterial sinusitis. She had been misdiagnosed as having autoimmune uveitis, treated with steroids and tropicamide, and underwent severe ocular hypertension and glaucoma despite posterior correct diagnosis.

Translated abstract

Resumo Relato de um caso de uma paciente do sexo feminino de meia idade que desenvolveu despigmentação bilateral simultânea aguda com dispersão de pigmentos na câmara anterior e discreta transiluminação após o uso de moxifloxacino oral para tratamento de sinusite bacteriana. Ela Havia sido diagnosticada com uveite autoimune e tratada com corticosteroide tópico e tropicamida e evoluiu com hipertensão ocular grave e glaucoma apesar de ,posteriormente, o diagnóstico ter sido correto.

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Most cited references 17

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Presumed fuchs heterochromic iridocyclitis and Posner-Schlossman syndrome: comparison of cytomegalovirus-positive and negative eyes.

Soon-Phaik Chee, Aliza Jap (2008)

To compare the characteristics of cytomegalovirus (CMV)-positive and negative eyes with presumed Posner-Schlossman syndrome (PSS) and Fuchs heterochromic iridocyclitis (FHI). Retrospective interventional case series. One hundred and three eyes of 102 patients with presumed PSS or FHI, seen at the Singapore National Eye Centre, underwent aqueous analysis for CMV by polymerase chain reaction (PCR). Their records were reviewed for clinical features and human immunodeficiency virus (HIV) status of the CMV-positive patients. The main outcome measures were age, gender, maximum intraocular pressure, endothelial cell count, endothelial changes, PCR results, and presence of uveitic cataract and/or glaucoma. Sixty-seven eyes with presumed PSS were tapped, of which 35 (52.2%) were CMV-positive. There were 36 eyes of 35 patients with presumed FHI, of which 15 (41.7%) were CMV-positive. All the CMV-positive patients were HIV negative. Nodular endothelial lesions were seen in 18 eyes (36.0%) with CMV infection, and reticulate deposits were seen in all the presumed FHI eyes. CMV-positive and CMV-negative PSS eyes were clinically similar. Older age at diagnosis, male gender, and nodular endothelial lesions were significantly associated with CMV infection in presumed FHI eyes (age: odds ratio [OR], 1.1; 95% confidence interval [CI], 1.0 to 1.2; P = .01; male gender: OR, 9.4; 95% CI, 1.0 to 88.6; P = .049; nodular endothelial lesions: OR, 13.9; 95% CI, 1.5 to 132.7; P = .02). There are no clinically detectable differences between CMV-positive and negative presumed PSS eyes. CMV-positive presumed FHI patients are more likely to be male, older at diagnosis or have nodular endothelial lesions.

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Bilateral acute iris transillumination.

Ilknur Tugal-Tutkun, P Kestelyn, Sumru Onal … (2011)

To describe a series of patients with bilateral acute iris transillumination, pigment dispersion, and sphincter paralysis. We reviewed the medical records and clinical photographs of 26 patients seen at 5 centers in Turkey and Belgium between March 16, 2006, and July 6, 2010. Observation procedures included clinical examination, anterior segment color photography, gonioscopy, laser flare photometry, and pupillometry. All 26 patients (20 women and 6 men; mean [SD] age, 43.2 [10.5] years) had bilateral involvement. Twenty-three patients (88%) had acute-onset disease with severe photophobia and red eyes. Nineteen patients (73%) had a preceding flulike illness and used systemic antibiotics, including moxifloxacin. Diagnostic laboratory workup was unremarkable. There was pigment discharge into the anterior chamber, and flare was elevated in the absence of inflammatory cells. Most patients had severe diffuse transillumination of the iris and mydriatic distorted pupils. Pupillometry revealed a compromised reaction to light. The most serious complication was an intractable early rise in intraocular pressure. Gonioscopy revealed heavy pigment deposition in the trabecular meshwork. Although symptoms were relieved promptly by application of topical corticosteroid, the median duration of pigment dispersion was 5.25 months. Bilateral acute iris transillumination with pigment dispersion and persistent mydriasis is a new clinical entity that is not an ocular adverse effect of oral moxifloxacin treatment, as previously suggested. The etiopathogenesis of this entity remains to be elucidated.

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Vitreous and aqueous penetration of orally administered moxifloxacin in humans.

William F. Mieler, Chun-hua Gao, Nancy Holekamp … (2006)

To investigate intraocular penetration of moxifloxacin hydrochloride after oral administration. Prospective study of 15 patients scheduled for vitrectomy between September and November 2004 at the Barnes Retina Institute, St Louis, MO. Aqueous, vitreous, and serum samples were analyzed from 15 patients after oral administration of 2 tablets containing 400 mg of moxifloxacin. Assays were performed using high-performance liquid chromatography. The mean +/- SD moxifloxacin concentrations in plasma (n = 15), vitreous (n = 13), and aqueous (n = 13) samples were 3.56 +/- 1.31 microg/mL, 1.34 +/- 0.66 microg/mL, and 1.58 +/- 0.80 microg/mL, respectively. Mean +/- SD sampling times after oral administration of the second moxifloxacin tablet for plasma, vitreous, and aqueous were 2.94 +/- 0.81 hours, 3.77 +/- 0.92 hours, and 3.71 +/- 0.89 hours, respectively. The percentages of plasma moxifloxacin concentration in the vitreous and aqueous were 37.6% and 44.3%, respectively. Minimal inhibitory concentrations against 90% levels were exceeded against a wide spectrum of gram-positive and gram-negative pathogens in the vitreous and aqueous. Moxifloxacin has a spectrum of coverage that encompasses the most common organisms in endophthalmitis. The pharmacokinetic findings of this investigation reveal that orally administered moxifloxacin achieves therapeutic levels in the noninflamed eye. Because of their broad spectrum of coverage, low minimal inhibitory concentration against 90% levels, good tolerability, and excellent oral bioavailability, fourth-generation fluoroquinolones may represent a major advance for managing posterior segment infections.

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Author and article information

Contributors

Renata A Rezende: Role: ND

Tiago Bisol: Role: ND

Taly Aldelsztajn: Role: ND

Flávio Rezende: Role: ND

André Curi: Role: ND

Journal

Journal ID (publisher-id): rbof

Title: Revista Brasileira de Oftalmologia

Abbreviated Title: Rev. bras.oftalmol.

Publisher: Sociedade Brasileira de Oftalmologia (Rio de Janeiro, RJ, Brazil )

ISSN (Print): 0034-7280

ISSN (Electronic): 1982-8551

Publication date (Print and electronic): December 2017

Volume: 76

Issue: 6

Pages: 312-315

Affiliations

[3] Rio de Janeiro orgnameFundação Oswaldo Cruz orgdiv1Laboratório em Pesquisa Clinica em Oftalmologia Infecciosa Brazil

[1] Rio de Janeiro Rio de Janeiro orgnamePontifícia Universidade Católica do Rio de Janeiro orgdiv1Departamento de Medicina Brazil

[2] Rio de Janeiro RJ orgnameInstituto de Diagnóstico e Terapia Ocular Brazil

Article

Publisher ID: S0034-72802017000600312

DOI: 10.5935/0034-7280.20170065

SO-VID: b7f7307e-6b41-4420-b84b-66c3d167fb7a

License:

This work is licensed under a Creative Commons Attribution 4.0 International License.

History

Date accepted : 27 September 2017

Date received : 26 April 2017

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Figures: 0, Tables: 0, Equations: 0, References: 17, Pages: 4

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SciELO Brazil

Keywords: Case reports,Anti-bacterial agents/adverse effects,Diagnosis, differential,Iridocyclitis/diagnosis,Transillumination,Pigment epithelium of eye/pathology,Iris diseases/diagnosis,Relatos de casos,Antibacterianos/efeitos adversos,Diagnóstico diferencial,Iridociclite/diagnóstico,Transiluminação,Epitélio pigmentado ocular/patologia,Doenças da íris/diagnóstico

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Keywords: Case reports, Anti-bacterial agents/adverse effects, Diagnosis, differential, Iridocyclitis/diagnosis, Transillumination, Pigment epithelium of eye/pathology, Iris diseases/diagnosis, Relatos de casos, Antibacterianos/efeitos adversos, Diagnóstico diferencial, Iridociclite/diagnóstico, Transiluminação, Epitélio pigmentado ocular/patologia, Doenças da íris/diagnóstico

Secondary glaucoma induced by bilateral acute depigmentation of the iris Translated title: Glaucoma secundário à despigmentação bilateral aguda da íris

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Most cited references 17

Presumed fuchs heterochromic iridocyclitis and Posner-Schlossman syndrome: comparison of cytomegalovirus-positive and negative eyes.

Bilateral acute iris transillumination.

Vitreous and aqueous penetration of orally administered moxifloxacin in humans.

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