%0 Journal Article
%T Moxifloxacin and bilateral acute iris transillumination
%A Robert M Knape
%A Fouad E Sayyad
%A Janet L Davis
%J Journal of Ophthalmic Inflammation and Infection
%D 2013
%I Springer
%R 10.1186/1869-5760-3-10
%X Dear editor:Recent publications have alerted clinicians to a syndrome of transilluminating iris depigmentation associated with the use of systemic fluoroquinolones and other antibiotics [1,2]. This syndrome, termed bilateral acute iris transillumination by some authors [1], differs from the previously described bilateral acute depigmentation of the iris, which causes reversible atrophy of the iris stroma without iris transillumination [3]. In contrast, fluoroquinolone-associated uveitis preferentially targets the iris pigment epithelium, leading to irreversible iris transillumination [2].We present a case of fluoroquinolone-associated uveitis with anterior segment optical coherence tomography (OCT) imaging to highlight some observations about this syndrome. We interpret pharmacokinetic data to help explain why oral, but not topical, moxifloxacin may cause fluoroquinolone-associated uveitis. We also discuss the possible impact of the presence of the native crystalline lens. Finally, we note that the anterior segment OCT findings suggest that both the iris stroma and iris pigment epithelium are affected in fluoroquinolone-associated uveitis.A 70-year-old Caucasian man complained of blurry vision and photophobia in both eyes for 2 weeks. His past medical history was notable for lung cancer and an episode of pneumonia treated with oral moxifloxacin 3 days before the ocular symptoms began. His visual acuity was 20/30 OD and 20/40 OS with intraocular pressures (IOP) of 35 mmHg in both eyes. He had mild corneal edema and symmetric 3+ anterior chamber pigmented cells (Figure 1A,B). Gonioscopy revealed dense pigment obscuring all angle structures (Figure 1C,D). The posterior segments were normal. Serum laboratory evaluation and polymerase chain reaction of the right eye aqueous humor were negative for HSV, VZV, and CMV. He was treated with topical steroids and cycloplegic and IOP-lowering medications with little change in vision, IOP, or pupil size. Retroillumination images
%K Moxifloxacin
%K Fluoroquinolone
%K Uveitis
%K Iris transillumination
%K Pigment dispersion
%U http://www.joii-journal.com/content/3/1/10