摘要
31 岁女性,因"双眼红痛 3 周"至门诊就诊,外院曾诊断虹膜睫状体炎,基础眼压正常,予以激素局部治疗.患者发病2个月余前第1次感染新型冠状病毒,1个月余前口服莫西沙星400 mg,每日1次,共6天.她的双眼最佳矫正视力:右眼 1.0,左眼 0.8,裂隙灯检查显示双眼角膜明,色素性KP(+),前房色素细胞(+),虹膜无后粘,瞳孔圆,直径 3 mm,对光反应灵敏,晶状体明,眼底检查无异常.眼压:右眼 36 mmHg(1 mmHg=0.133 kPa),左眼 33 mmHg.风湿免疫指标正常.房角镜示双眼开角、房角Ⅳ级色素.诊断为双眼急性虹膜脱色素、双眼激素性高眼压.逐渐停激素,眼压逐渐控制平稳.讨论体会:双眼急性虹膜脱色素需要询问有无使用第四代喹诺酮类药物病史,同时要与虹膜睫状体炎和色素播散综合征(色素性青光眼)鉴别.
Abstract
A 31-year-old female was admitted with complaints of redness and pain in her both eyes for three weeks.She was once diagnosed with iridocyclitis in the other hospital with normal baseline intraocular pressure(IOP),and was treated with topical corticosteroids.She was infected with COVID-19 over 2 months prior to the onset of ocular symptoms and took oral moxifloxacin(400 mg once a day)for 6 days over 1 month ago.Her best corrected visual acuity was 1.0 in her right eye and 0.8 in her left eye.Slit lamp biomicroscopy showed transparent cornea,1+ pigmented keratic precipitates,1+ pigments in the anterior chamber without posterior synechia of the iris,round pupils with a diameter of 3 mm and sensitive to light,and transparent lens in both eyes.Fundus examination was unremarkable.Her IOP was 36 mmHg and 33 mmHg in her right and left eye,respectively.The results of rheumatoid factors were within normal range.Gonioscopy revealed open angles with heavy pigmentation at the trabecular meshwork(Grade Ⅳ)in both eyes.She was diagnosed with bilateral acute depigmentation of iris(BADI)and corticosteroid-induced ocular hypertension.After the corticosteroid was tapered,her IOP gradually stabilized.It must be kept in mind that we should inquire about the history of using fourth-generation quinolones when considering BADI.Simultaneously,it is essential to differentiate BADI it from iridocyclitis and pigment dispersion syndrome(pigmentary glaucoma).
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