Bilateral acute iris transillumination (BAIT) syndrome: literature review

Figures & data

Table 1 Description of all the described cases of bilateral acute iris transillumination (BAIT) syndrome, with analysis of their geographical location, gender, age and ethnicity of the patients, and possible links to upper respiratory tract infections or oral antibiotics

Reference, year	Journal	N	Gender	Mean age (years)	Ethnic origin	Location^a	Upper airway infection	Documented antibiotic uptake
Wefers Bettink-Remeijer et al, 2009^Citation2	Eye	5	3F 2M	52.6	NS	Netherlands (3)		Moxifloxacine per os (5)
Hinkle et al, 2011^Citation11 (literature review)	Cutan Ocul Toxicol	14^b	NP	NP	NS	NP	NP	NP
Tugal - Tutkun et al, 2011^Citation3	Arch Ophthalmol	26	20F 6M	43.2	NS	Turkey, Belgium*	Yes, 19	Moxifloxacine (9) Ampicilline - sulfabactam (2) Amoxicilline clavulanate (2) Triméthoprime sulfaméthoxazole (1) Céfixime (1) Pénicilline V (1) NP (3)
Morshedi et al, 2012^Citation14	Ocul Immunol Inflamm	2	1F 1M	54	NS	Turkey	Yes	Moxifloxacine IV (1) Amoxicilline per os puis moxifloxacine per os (1)
Knape et al, 2013^Citation18	Journal of Ophthalmic Inflammation and Infection	1	M	70	Caucasian	USA	Yes	Moxifloxacine per os
Duncombe et al, 2013^Citation19	Journal français d’ophtalmologie	1	M	61	NS	France	Yes	Moxifloxacine per os
Jang et al, 2015^Citation4	Klin Monbl Augenheilkd	2	2F	52	NS	Switzerland	Yes, 1	Moxifloxacine per os (2)
Gonul et al, 2015^Citation5	Cutan Ocul Toxicol.	1	F	50	NS	Turkey	No	No**
Gonul et al, 2015^Citation8	Arq Bras Oftalmol	1	M	30	NS	Turkey	Yes	Céfazoline
Degirmenci, et al,2016^Citation6	Saudi Journal of Ophthalmology	1	M	33	NS	Turkey	No***	No
Kreps et al, 2017^Citation12	Acta Ophthalmologica	12	11F 1M	52.3	NS	Belgium	Yes, 10****	Oral Moxifloxacine (11)
Den Beste et al, 2017^Citation23	Medicine (Baltimore)	1	F	55	NS	USA	Yes	Oral Moxifloxacine
Perone et al, 2017^Citation7	Journal français d’ophtalmologie	1	F	42	Caucasian	France	No	No
Altan et al, 2018^Citation25	Indian J Ophthalmol	1	M	47	NS	Turkey	Yes	Oral Moxifloxacine + oral Amoxicilline
Tranos et al, 2018^Citation13	Eye	16	14F 2M	43	NS	Greece	Yes, 11	Oral Moxifloxacine (13) Clarithromycine (3)
Hernandez Pardines et al, 2018^Citation27	Arch Soc Esp Oftalmol	1	F	51	NS	Spain	Yes	Oral Moxifloxacine
Kawali et al, 2019	Can J ophthalmol	5	3M 2F	40.5	Indian	India	No	Oral Moxifloxacine (1) Topical Moxifloxacine (3) NP(1)

Notes: *Multicenter study carried out in Turkish and Belgian centers. The number of patients in each country has not been specified. **No antibiotic intake, but fumigation therapy. ***Concomitant urinary tract infection reported. ****10 patients had moxifloxacin for upper or lower airway infection, and another for erysipelas. ^aLocation where the diagnosis was made: since the ethnic origins of the cases presented here are not generally specified, we considered it useful to report the country where the diagnosis was made. ^bThe study actually reports 40 cases of bilateral uveitis possibly related to fluoroquinolones, including 33 new cases specifically reported by the authors (the others being cases of the literature at the time), but only 14 of these cases presented a bilateral iris transillumination that can be integrated into an authentic BAIT syndrome. The study does not specify the demographic characteristics of these 14 particular cases, nor the antibiotics taken by them.

Abbreviation: NS, not specified.

Figure 1 World map illustrating the distribution of the described cases of bilateral acute iris transillumination (BAIT) syndrome around the world.

Figure 2 Bilateral acute depigmentation of the iris (BADI) syndrome with typical peripheral patchy loss of iris pigmentation. It is difficult to appreciate depigmentation. Iris autofluorescence has been described to enhance loss of pigments.

Figure 3 Typical picture of bilateral acute iris transillumination (BAIT) syndrome with iris transillumination on slit lamp examination and pupil deformation with associated semi-mydriasis. Notes: Picture reproduced from Perone JM, Reynders S, Sujet-Perone N, et al. Le syndrome de transillumination bilatérale aiguë de l’iris: case report [Bilateral acute iris transillumination: case report]. J Fr Ophtalmol. 2017;40(8):713-716. French. Copyright 2017, Elsevier Masson SAS. All rights reserved.⁷

Wefers Bettink-Remeijer M, Brouwers K, van Langenhove L, et al. Uveitis-like syndrome and iris transillumination after the use of oral moxifloxacin. Eye (Lond). 2009;23(12):2260–2262. doi:10.1038/eye.2009.234

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Hinkle DM, Dacey MS, Mandelcorn E, et al. Bilateral uveitis associated with fluoroquinolone therapy. Cutan Ocul Toxicol. 2012;31(2):111–116. doi:10.3109/15569527.2011.617024

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Tugal-Tutkun I, Onal S, Garip A, et al. Bilateral acute iris transillumination. Arch Ophthalmol. 2011;129(10):1312–1319. doi:10.1001/archophthalmol.2011.310

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Morshedi RG, Bettis DI, Moshirfar M, Vitale AT. Bilateral acute iris transillumination following systemic moxifloxacin for respiratory illness: report of two cases and review of the literature. Ocul Immunol Inflamm. 2012;20(4):266–272. doi:10.3109/09273948.2012.670359

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Knape RM, Sayyad FE, Davis JL. Moxifloxacin and bilateral acute iris transillumination. J Ophthalmic Inflamm Infect. 2013;3(1):10. doi:10.1186/1869-5760-3-10

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Duncombe A, Gueudry J, Massy N, Chapuzet C, Gueit I, Muraine M. [Severe pseudouveitis associated with moxifloxacin therapy]. J Fr Ophtalmol. 2013;36(2):146–150. doi:10.1016/j.jfo.2012.07.002

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Jang L, Borruat F-X, Guex-Crosier Y. Bilateral acute iris transillumination: a rare cause of iris atrophy. report of 2 cases. Klin Monbl Augenheilkd. 2015;232(4):593–594. doi:10.1055/s-0035-1545744

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Gonul S, Bozkurt B, Okudan S, Tugal-Tutkun I. Bilateral acute iris transillumination following a fumigation therapy: a village-based traditional method for the treatment of ophthalmomyiasis. Cutan Ocul Toxicol. 2015;34(1):80–83. doi:10.3109/15569527.2014.886589

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Gonul S, Bozkurt B. Bilateral acute iris transillumination (BAIT) initially misdiagnosed as acute iridocyclitis. Arq Bras Oftalmol. 2015;78(2):115–117. doi:10.5935/0004-2749.20150029

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Degirmenci C, Guven Yilmaz S, Palamar M, Ates H. Bilateral acute iris transillumination: case report. Saudi J Ophthalmol. 2016;30(2):122–124. doi:10.1016/j.sjopt.2015.11.009

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Kreps EO, Hondeghem K, Augustinus A, et al. Is oral moxifloxacin associated with bilateral acute iris transillumination? Acta Ophthalmol. 2017. doi:10.1111/aos.13558

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Den Beste KA, Okeke C. Trabeculotomy ab interno with Trabectome as surgical management for systemic fluoroquinolone-induced pigmentary glaucoma: a case report. Medicine (Baltimore). 2017;96(43):e7936. doi:10.1097/MD.0000000000007936

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Perone JM, Reynders S, Sujet-Perone N, et al. Le syndrome de transillumination bilatérale aiguë de l’iris: case report [Bilateral acute iris transillumination: case report]. J Fr Ophtalmol. 2017;40(8):713-716. French. doi:10.1016/j.jfo.2017.01.018

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Altan C, Basarir B, Kesim C. An unexpected complication in bilateral acute iris transillumination: cystoid macular edema. Indian J Ophthalmol. 2018;66(6):869–871. doi:10.4103/ijo.IJO_1134_17

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Tranos P, Lokovitis E, Masselos S, Kozeis N, Triantafylla M, Markomichelakis N. Bilateral acute iris transillumination following systemic administration of antibiotics. Eye (Lond). 2018;32(7):1190–1196. doi:10.1038/s41433-018-0054-y

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Hernández Pardines F, Serra Verdú MC, Font Juliá E, Molina Martin JC. Aqueous humor misdirection syndrome after glaucoma filtering surgery in patient with bilateral acute iris transillumination (BAIT) syndrome. Arch Soc Esp Oftalmol. 2018;93(9):444–446. doi:10.1016/j.oftal.2018.03.010

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