Bilateral acute depigmentation of the iris: report of 26 new cases and four-year follow-up of two patients.
OBJECTIVE
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.


METHODS
A retrospective case series.


METHODS
Twenty-six Turkish patients who were diagnosed with BADI between 2006 and 2008 and 2 patients who were reported previously.


METHODS
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.


METHODS
Demographic features, presenting symptoms, laboratory findings, changes in iris stromal pigment and architecture, and time to resolution of pigment dispersion in the anterior chamber.


RESULTS
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.


CONCLUSIONS
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.
Tugal-Tutkun
Ilknur
I
Istanbul University, Istanbul Faculty of Medicine, Department of Ophthalmology, Istanbul, Turkey. itutkun@istanbul.edu.tr
Araz
Bilge
B
Taskapili
Muhittin
M
Akova
Yonca A
YA
Yalniz-Akkaya
Züleyha
Z
Berker
Nilüfer
N
Emre
Sinan
S
Gezer
Acun
A
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000869:Anterior Eye Segment / Q000473:pathology; D017889:Exfoliation Syndrome / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality; D005938:Glucocorticoids / Q000008:administration & dosage; D006068:Gonioscopy; D006801:Humans; D017496:Hypopigmentation / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D007498:Iris / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010857:Pigment Epithelium of Eye / Q000473:pathology*; D012189:Retrospective Studies; D014792:Visual Acuity; D055815:Young Adult
D005938:Glucocorticoids