Unilateral acute iris depigmentation and transillumination after glaucoma surgery with mitomycin application and intracameral moxifloxacin

PURPOSE: Bilateral acute iris depigmentation (BADI) and transillumination (BATI) syndromes have been linked with the use of antibiotics, especially fluoroquinolones. They are characterized by acute onset of pigment dispersion in the anterior chamber, depigmentation of the iris and pigment deposition in the angle and in the posterior surface of the cornea (BADI), with iris transillumination defects and atonic pupil with sphincter paralysis (BATI). The purpose of this paper is to report the development of clinical depigmentation and iris damage similar to BADI and BATI in patients who had undergone uneventful glaucoma surgery with intracameral moxifloxacin as prophylaxis for endophthalmitis. OBSERVATIONS: Four patients who had undergone Ex-Press implantation (cases 1 and 2) or non-penetrating deep sclerotomy (cases 3 and 4) developed asymptomatic pigment dispersion in the anterior chamber, which cleared after treatment with topical corticosteroids and NSAIDS. However, pupillary damage ensued, with mid-midriasis and pigment deposition under the filtration bleb. CONCLUSIONS AND IMPORTANCE: This is, to the best of our knowledge, the first report of acute unilateral iris depigmentation and transillumination after intracameral use of moxifloxacin. Moxifloxacin's toxic effect may have been promoted by the subconjuntival mitomycin employed to prevent scarring at the filtration bleb. Surgeons should be aware of these potential side-effects of drugs used as widely as moxifloxacin and mitomycin.