Bilateral Acute Depigmentation of Iris (BADI) and Bilateral Acute Iris Transillumination (BAIT)Following Acute COVID-19 Infection

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

“…7 It is noteworthy that there are also cases with mixed BADI and BAIT features in one or both eyes (Figure 3) or BADI in one eye and BAIT in the other eye. 7,18 These findings support the notion that BADI and BAIT may represent different phenotypes of the same disease process. It is not clear why iris stromal pigment is exclusively affected in some patients, causing only the BADI picture without any transillumination defects or pupillary abnormalities, whereas the iris pigment epithelium is exclusively affected in others, causing the typical BAIT picture with diffuse transillumination and paralytic mydriatic pupils.…”

“…21 In a more recent series, 7 (29%) of 24 BAIT eyes required trabeculectomy. 18 The time from symptom onset to trabeculectomy ranged between 1 and 12 months and IOP was successfully controlled in all cases after surgery. 18 Absence of intraocular inflammation may be an important factor in the long-term success of trabeculectomy despite ongoing pigment dispersion in the aqueous humor.…”

“…3,10,13,19,34 During the recent COVID-19 pandemic, a total of 19 cases of BADI and BAIT were reported, 18 cases from Turkey and 1 from India. 16,18,34,35 In the recent series of 16 patients from Turkey (12 with BAIT and 4 with BADI), the mean interval between the COVID-19 infection and onset of ocular symptoms was 2.5 weeks. 18 Nine patients were treated with oral moxifloxacin and 4 patients with other antibiotics.…”

“…By contrast, BADI has a more benign course with a shorter duration of pigment discharge from the iris stroma, a lower incidence of IOP rise that is only transient, and iris changes that can be reversible. 3,4,5,7,12,18…”

“…12 Dense pigment deposition in the trabecular meshwork explains the earlier and more severely elevated IOP in BAIT compared to BADI patients. 3,12,18 In the original BAIT series reported by Tugal-Tutkun et al, 12 54% of the patients had IOP rise during the disease course, and two patients with 4+ pigment in the anterior chamber required bilateral trabeculectomy with mitomycin C (MMC) at 3 and 9 weeks after symptom onset. Kreps et al 19 reported ocular hypertension (OHT) in 4 (33%) of 12 BAIT patients, which was controlled with antiglaucoma drops in all cases.…”