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• W4289783313 abstract "The authors have reported an interesting case of bilateral acute depigmentation of iris (BADI) following coronavirus disease 2019 (COVID-19) infection.[1] I credit the authors for good clinical work-up and management of this case. In addition, some important points are highlighted here. BADI is a relatively new pathological entity, where pathophysiology and etiological causes are still not fully understood. The clinical entity of BADI was first described by Tutkun et al.[2] in 2006 in their series of five patients. They observed unusual bilateral stromal depigmentation of the iris and pigment dispersion in the anterior chamber in their series, which was distinct from known entities like Fuchs’ uveitis syndrome, pigment dispersion syndrome, viral uveitis, and Horner’s syndrome. Subsequently, there have been reports of BADI following the use of fluoroquinolones.[34] Fluoroquinolones form complexes with melanin, which accumulate in iris tissue resulting in toxic effects.[5] However, baseline febrile illness in patients with fluoroquinolone use is more consistently related to BADI than the antibiotic use itself. BADI has been reported in patients following febrile illness even in the absence of fluoroquinolone use. Of late, there has been emerging evidence of viral etiologies such as cytomegalovirus, herpes simplex, and herpes zoster.[67] Iris ischemia and neurotrophic mechanisms are other proposed etiological mechanisms for BADI. Recently, Patnaik et al.[8] reported a case of BADI post COVID-19 infection in a young female who also had a history of exposure to moxifloxacin. Yagci et al.[9] reported a case of bilateral acute iris transillumination (BAIT), a clinical entity closely associated with BADI in a patient following an episode of COVID-19 pneumonitis. COVID-19 has been associated with a wide variety of ocular manifestations ranging from conjunctivitis to vein occlusions and uveitis.[10] Direct cytotoxic effects of virus, immune-mediated damage, and microangiopathy are the possible pathogenetic mechanisms implicated. Similarly, any of these mechanisms might be responsible for iris depigmentation. However, in the absence of concrete molecular and cytological evidence, the etiological associations of BADI remain conjectural. Irrespective of the possible etiology, BADI is usually a self-limited disease and requires symptomatic treatment in the form of cycloplegics and topical steroids. Oral antiviral therapy is often added empirically but there is no definitive evidence in the literature to support the same. It is important to know that in view of limited knowledge about BADI currently, the diagnosis should only be made after ruling out all the possible etiologies like viral uveitis, Fuchs’ uveitis, and pigment dispersion syndrome. Molecular and microbiological analysis of aqueous fluid and application of newer imaging techniques like iris fluorescein angiography and optical coherence tomography angiography can play a useful role in future studies to understand this unique clinical entity." @default.
• W4289783313 created "2022-08-04" @default.
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• W4289783313 date "2022-01-01" @default.
• W4289783313 modified "2023-10-18" @default.
• W4289783313 title "Commentary: COVID-19-related bilateral acute depigmentation of iris with ocular hypertension" @default.
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• W4289783313 doi "https://doi.org/10.4103/ijo.ijo_1297_22" @default.
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