Masquerade As Pigment Dispersion: Bait Or Uhg?

To report a unilateral bilateral acute iris transillumination (BAIT)-like clinical picture following uneventful routine phacoemulsification and intraocular lens implantation surgery.

This study was conducted at Ege University Faculty of Medicine, Department of Ophthalmology, Turkey. A 77-year-old male patient was referred to our clinic due to treatment-resistant elevated intraocular pressure (IOP) and pigment dispersion (PD) in his right eye.

At the initial examination, the best-corrected visual acuity (BCVA) was 20/25 in the right eye (OD) and 20/20 in the left eye (OS). IOP was 36 mmHg with dorzolamide/timolol combination 2x1 and brimonidine tartrate 2x1 in OD and 13 mmHg in OS. Biomicroscopic examination revealed 4+ PD in the anterior chamber, along with minimal diffuse iris transillumination and pigment accumulation in the corneal endothelium. Gonioscopy revealed a dense accumulation of pigment covering the iridocorneal angle. No backward bowing of the iris was observed in the anterior segment optical coherence tomography. No pathology was found in the posterior segment, including any glaucomatous defect.

The patient had undergone uneventful cataract surgery 5 months ago, and he had started experiencing decreased vision, redness, and photophobia after the acute post-operative period. There was no recent history of moxifloxacin use or infection. After adding a prostaglandin analog and a high-potency steroid to the current treatment, it was observed that PD decreased to +1, and IOP returned to normal limits during the follow-up.

The etiology of BAIT, first described in 2006, remains unclear. Unilateral BAIT following cataract surgery was documented in 4 cases, all associated with the use of moxifloxacin in the anterior chamber. While Uveitis-Glaucoma- Hyphaema Syndrome (UGH) has evolved beyond its classical triad, particularly with modern IOLs, hyphema and sulcus-located IOLs continue to be significant factors in the diagnosis. PD and elevated IOP in pseudophakic patients bring BAIT and UGH to mind. However, in some instances, making a differential diagnosis and reaching a definitive conclusion can be quite challenging.