Bilateral Acute Depigmentation Of The Iris Research Articles

Bilateral Acute Depigmentation of the Iris Following Refractive Surgery - An Untold Story

Bilateral Acute Depigmentation of the Iris Following Refractive Surgery - An Untold Story

Features of the Course and Rare Ophthalmic Manifestations of Post-COVID Syndrome

The review presents data from studies of the ophthalmological consequences of the disease caused by SARS-CoV-2, especially regarding its rare manifestations. Clinical manifestations of the post-COVID-19 syndrome disappear within about two weeks in mild cases and 3 to 12 weeks in more severe cases. 80 % of patients have more than one, often more than two, and more than 10 symptoms. In general, patients improve spontaneously and continuously over time. The ophthalmic manifestations of COVID-19 vary in nature, severity, and timing, and are more common in patients with severe systemic disease, abnormal blood counts, and inflammatory conditions. Ophthalmic manifestations can develop at any time during the course of the disease. The median time to symptom onset since COVID-19 diagnosis is 5 days for neuro-ophthalmic manifestations, 8.5 days for the ocular surface and anterior segment of the eye, and 12 days for the posterior segment and orbit. COVID-19 causes ocular manifestations in approximately 11 % of patients. The most common ocular manifestation is conjunctivitis, which affects almost 89 % of patients with eye diseases. Other much less common anterior segment anomalies caused by SARS-CoV-2 include scleritis, episcleritis, and acute anterior uveitis. Posterior segment injuries caused by SARS-CoV-2 are mainly vascular, such as hemorrhages, cotton wool spots, dilated veins, and vasculitis. Rare complications of COVID-19 include rhino-orbital-cerebral mucormycosis; retrobulbar optic neuropathy, papillitis, neuroretinitis, anterior ischemic optic neuropathy, non-arterial anterior ischemic optic neuropathy; retinal white spot syndrome (MEWDS); acute unilateral anterior uveitis, serpiginous choroiditis; bilateral central serous chorioretinopathy; bilateral acute depigmentation of the iris, bilateral acute transillumination of the iris; refraction changes; complications associated with drugs used to treat COVID-19 that have toxic effects on eye tissue; and vaccine-associated uveitis.

Bilateral Acute Depigmentation of Iris (BADI) and Bilateral Acute Iris Transillumination (BAIT)-An Update.

Bilateral acute depigmentation of the iris (BADI) and bilateral acute iris transillumination (BAIT) are relatively new clinical entities characterized by acute pigment dispersion from the iris stroma or iris pigment epithelium, respectively. While BADI presents with diffuse or geographic areas of iris stromal depigmentation without transillumination, BAIT cases typically develop diffuse iris transillumination and mydriatic atonic pupils. Prolonged pigment dispersion and ocular hypertension are more common in BAIT. Although the exact etiopathogenesis is still unknown, moxifloxacin toxicity appears to be a probable/likely cause. The underlying cause of BADI or BAIT in patients who were not exposed to fluoroquinolone antibiotics remains unexplained. Systemic viral infections, including coronavirus disease 2019, may be the triggering event in several cases.

Clinical analysis of bilateral acute depigmentation of the iris: first reported case in China.

Clinical analysis of bilateral acute depigmentation of the iris: first reported case in China.

A case of bilateral acute depigmentation of the Iris in one of two identical twins

BackgroundBilateral Acute Depigmentation of the Iris (BADI) is a condition which was first described in a case series from Turkey by Tugal-Tutkin and Urgancioglu in (Graefes Arch Clin Exp Ophthalmol 244:742-6, 2006). The condition is characterized by bilateral acute depigmentation and discoloration of the iris stroma, pigment dispersion, and deposition of pigment in the angle. In our case we report a patient who developed BADI after receiving pitcher plant extract injections for chronic migraine, while her identical twin sister has normal iris architecture and pigmentation and never received any pitcher plant injections.Case presentationPatient is a 41-year-old female with history of pitcher plant extract injections to her face for chronic migraine, who later developed bilateral depigmentation of the iris. She did not have any signs of anterior segment uveitis or iridocyclitis. She has an identical twin sister who maintained normal iris pigmentation during the entire course.ConclusionsBilateral Acute depigmentation of the is a recently discovered condition described in the literature in Turkish patients (Tugal-Tutkun and Urgancioglu, Graefes Arch Clin Exp Ophthalmol 244:742-6, 2006; Tugal-Tutkun et al., Ophthalmology 116(8):1552-7, 2009). This condition affects mainly young females and is characterized by acute bilateral stromal depigmentation, without other pathologic ocular findings. These patients usually maintain normal vision and do not develop significant glaucoma from pigment collecting in the anterior chamber angle. This condition can be mistaken for Fuchs’ heterochromic iridocyclitis, pigment dispersion syndrome, pseudoexfoliation syndrome, and viral iridocyclitis. This is the first reported case in North America and is important for differentiation from the above pathologies. Our patient had a history of pitcher plant extract injections to the face but it is unclear if this is associated with our patient’s development of BADI. As awareness of this condition progresses, a possible etiology may be elucidated.

Bilateral acute iris transillumination (BAIT) syndrome: literature review.

The authors conducted a literature review about bilateral acute iris transillumination (BAIT) syndrome, a new and relatively unknown syndrome that should be described and made known to the greatest number to avoid potential diagnostic and therapeutic errors. The first cases date back only to 2004 and a total of 79 cases have been published to date, mainly in Europe and especially in Turkey and Belgium. It mainly affects young women between the ages of 30 and 50, and symptoms are often preceded by an upper airway infection. There is also a majority of cases where the onset of the syndrome follows oral intake of moxyfloxacin. The clinical signs are dominated by strong photophobia, secondary to a spectacular transillumination of the iris. Other classical symptoms are conjunctival infection, eye pain, blurred vision, temporary ocular hypertonia, fixed mid-dilated pupils, and pigment dispersion in the anterior chamber with pigmentary deposits in the trabecular meshwork in gonioscopy, symptoms that may be mistaken for uveitis. After a few weeks or months of evolution, persistent sequelae were pupillary atony and chronic and bilateral transillumination of the iris, leading to significant photophobia and sometimes persistent ocular hypertension. The BAIT syndrome is close to the bilateral acute depigmentation of the iris (BADI) syndrome, which is similar to BAIT but lacks associated transillumination. A few cases of patients with BAIT syndrome on one eye and BADI syndrome on the contralateral eye have been described, which confirms some form of link between the two clinical entities.

Bilateral Acute Depigmentation of the Iris: Findings in Anterior Segment Swept-Source Optical Coherence Tomography

ABSTRACTObjective: To describe the clinical and Anterior Segment Swept-Source Optical Coherence Tomography (AS-SS OCT) findings in Bilateral Acute Depigmentation of the Iris (BADI).Design: Retrospective descriptive study of three clinical cases.Results: Three women diagnosed with BADI shared a history of bacterial infections treated with moxifloxacin. The AS-SS OCT showed damage from the collarette to the root of the iris, without affecting the pupillary area. In the affected areas, the anterior edge had lost its homogeneous hyper-reflectivity. The stroma was thinned and showed a patchy and diffused hyper-reflectivity. The pigmentary epithelium appeared unaffected.Conclusions: AS-SS OCT findings, not previously described, locate the damage in BADI in the anterior edge and iridian stroma, areas which are rich in melanocytes and permeable to aqueous humor.

Bilateral acute depigmentation of the iris in two siblings simultaneously

PurposeTo report the first simultaneous onset of bilateral acute depigmentation of the iris (BADI) in two siblings. ObservationsTwo sisters presented with bilateral ocular pain, redness and light sensitivity. Examination revealed bilateral circulating pigment in the anterior chamber with pigment dusting on backs of the corneas, patchy iris depigmentation and heavy pigment deposition in the angle. Both patients had recently suffered from upper respiratory tract infections. Bilateral visual acuities were preserved and no transillumination defects were observed. The patients were diagnosed with BADI. Both cases were successfully controlled with topical corticosteroids and anti-glaucoma drops as well as topical glanciclovir gel. Conclusions and ImportanceTo date, there had been no published reports of BADI in the Middle East and Africa. This is the first observation of this entity in these regions. Moreover it is the first occurrence of BADI in two immediate siblings simultaneously. We also report the rare asymmetrical presentation with BADI in one of our patients. These observations point to the possibility of genetic factors underlying BADI as well as an infectious cause behind the etiology.

Bilateral acute depigmentation of iris: 3-year follow-up of a case

Bilateral acute depigmentation of the iris (BADI) usually affecting young women, is a newly defined clinical diagnosis with bilateral symmetrical pigment loss of iris stroma without iris transillumination defect. Herein, we want to share the results of a 3-year-long follow-up of a 23-year old female patient with BADI. She was admitted to our clinic with a complaint of discoloration of both her brown irises. An ocular evaluation of the patient revealed symmetrical pigment deposition in trabecular meshwork. No iris transillumination defect, pupillary sphincter paralysis, keratic precipitates, and inflammatory reaction in anterior chamber were seen. The depigmented iris stroma became repigmented symmetrically after 3-year follow-up period. Although it is rare, BADI should be considered in the differential diagnosis of the diseases with bilateral iris depigmentation.

Secondary glaucoma induced by bilateral acute depigmentation of the iris

Relato de um caso de uma paciente do sexo feminino de meia idade que desenvolveu despigmentacao bilateral simultânea aguda com dispersao de pigmentos na câmara anterior e discreta transiluminacao apos o uso de moxifloxacino oral para tratamento de sinusite bacteriana. Ela Havia sido diagnosticada com uveite autoimune e tratada com corticosteroide topico e tropicamida e evoluiu com hipertensao ocular grave e glaucoma apesar de ,posteriormente, o diagnostico ter sido correto. Glaucoma secundario a despigmentacao bilateral aguda da iris

Bilateral acute depigmentation of the iris (BADI): first reported case in Brazil

Bilateral acute depigmentation of the iris (BADI) is a recently described entity characterized by acute onset of pigment dispersion in the anterior chamber, depigmentation of the iris, and heavy pigment deposition in the anterior chamber angle. Involvement is always bilateral, simultaneous, and symmetrical. We report the case of a 61-year-old man who presented with bilateral ocular pain, red eyes, and severe photophobia. Examination revealed a dense Krukenberg spindle, heavy pigment dispersion in the anterior chamber, extensive transillumination iris defects, and a heavy pigment deposition in the trabecular meshwork bilaterally. Intraocular pressure increased to 48 mmHg in both eyes. The patient received topical steroids, maximum hypotensive treatment and oral valacyclovir. Intraocular pressure gradually decreased throughout the second and third months, and medications were gradually tapered. The time to complete resolution of pigment dispersion was 18 weeks. Visual acuity and visual fields remained normal, but the photophobia was permanent.

Moxifloxacin and bilateral acute iris transillumination

Recent publications have alerted clinicians to a syndrome of uveitic transilluminating iris depigmentation associated with systemic fluoroquinolones and other antibiotics. Bilateral acute iris transillumination, which is associated with loss of the iris pigment epithelium and results in iris transillumination, differs from the previously described bilateral acute depigmentation of the iris, which is associated with atrophy of the iris stroma without transillumination. We present a case of fluoroquinolone-associated uveitis with anterior segment optical coherence tomography 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.

Bilateral acute depigmentation of the iris first misdiagnosed as acute iridocyclitis

Acute depigmentation of the iris is a new condition characterized by pigment dispersion in the anterior chamber, depigmentation of the iris stroma, and pigment deposition in the anterior chamber angle. A 33-year-old woman using a topical corticosteroid every 2 h for the treatment of acute iridocyclitis was referred to our clinic to seek another opinion because her symptoms had not improved. An ocular evaluation of the patient revealed pigment precipitates on the corneal endothelium, pigment dispersion in the anterior chamber, symmetrical diffuse depigmentation, granularity of the iris stroma, and pigment deposition in the trabecular meshwork. These findings suggested a diagnosis of bilateral acute depigmentation of the iris (BADI) instead of iridocyclitis. Clinicians should be careful in the differential diagnosis of iris depigmentation from iridocyclitis to avoid the unnecessary use of high-dose topical corticosteroids.

Bilateral Acute Depigmentation of the Iris: Report of 26 New Cases and Four-year Follow-up of Two Patients

To report new cases of bilateral acute depigmentation of the iris (BADI), a recently described clinical entity, and to report the 4-year follow-up of 2 patients that was published previously. A retrospective case series. Twenty-six Turkish patients who were diagnosed with BADI between 2006 and 2008 and 2 patients who were reported previously. We reviewed the patients' charts and clinical photographs. Observation procedures included clinical examination, anterior segment color photography, laser flare photometry, and pupillometry. We performed an anterior chamber tap in 2 patients for polymerase chain reaction (PCR) to demonstrate the DNA of herpes simplex virus (HSV), varicella zoster virus (VZV), and cytomegalovirus (CMV) in the aqueous samples. Demographic features, presenting symptoms, laboratory findings, changes in iris stromal pigment and architecture, and time to resolution of pigment dispersion in the anterior chamber. Nineteen patients were female, and 7 patients were male. Mean age was 32.3+/-8.6 years. All had bilateral involvement. Twenty patients (76.9%) presented with photophobia and red eyes, and 4 patients (15.4%) presented with a recent change in eye color. Ten patients (38.5%) had flu-like symptoms preceding the onset of ocular symptoms. Diagnostic laboratory workup, viral serology, and PCR analysis of the aqueous humor were unrewarding. Diffuse depigmentation of the iris stroma from the collarette to the iris root was seen in 16 patients, and geographic areas of depigmentation were seen in 10 patients. There was heavy pigment deposition in the trabecular meshwork in all patients. Anterior chamber flare was elevated in eyes with circulating pigment. The pupil was not affected. Twenty patients received topical corticosteroids. Pigment dispersion resolved in 1 to 16 weeks (median, 9 weeks). The intraocular pressure was elevated in 8 steroid-treated eyes but was controlled with antiglaucomatous medications. In 2 patients reported previously, the depigmented iris stroma became repigmented after 4 years. Patients with BADI present with bilateral, symmetrical, nontransilluminating depigmentation of the iris stroma and pigment discharge into the anterior chamber. Young female persons are more commonly affected. The cause remains unknown. After 4 years, the ocular findings in 2 patients normalized.