Abstract
PurposeTo study the macular features in Eales disease patients observed with fundus fluorescein angiography (FA), optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA).MethodsA cross-sectional study was done on treatment naïve 31 eyes (23 patients) with Eales disease. Baseline parameters such as Best-corrected visual acuity (BCVA), slit-lamp bio microscopy (SLB), indirect ophthalmoscopy, FA, spectral-domain OCT {quantitative (central macular thickness [CMT]) and qualitative analysis on SD-OCT} and OCTA were performed. Any media opacity precluding the above investigations was excluded.ResultsMacular findings comprised of- epiretinal membrane, macular exudation, full thickness macular hole, sub internal limiting membrane bleed, cystoid macular oedema, neurosensory detachment and retinal thickening. Sixteen (51.6%) of our patients had macular changes as seen on all modalities together. SLB and indirect ophthalmoscopy missed macular findings in 50% patients and FA in 18.8% patients. OCT and OCTA diagnosed all macular findings. On comparison of mean BCVA in patients with macular involvement on FA, OCT and OCTA, compared to those without macular involvement, patients with macular involvement had lower BCVA (p 0.000, 0.01 and 0.001 respectively). Thus, FA missed many patients who had significant macular involvement and hence less vision.ConclusionEales disease though described in literature as classically being peripheral retina disease process, also has macular involvement. OCT and OCTA are useful guides to evaluation of macular involvement in these patients. The latter seems to be superior to FA in detecting macular abnormalities in this ailment. OCTA is non-invasive and shows deep capillary plexus changes which are not shown by any other modality.
Highlights
Eales disease was first described by the British ophthalmologist Henry Eales in 1880
slit-lamp bio microscopy (SLB) and indirect ophthalmoscopy (IO) missed the finding in 8 patients (50%) out of total patients with macular involvement
Comparison of foveal avascular zone on FFA and optical coherence tomography angiography (OCTA) We studied the foveal avascular zone in detail on FFA and OCTA
Summary
Eales disease was first described by the British ophthalmologist Henry Eales in 1880. There is a vicious cycle of retinal inflammation, hypoxia and neovascularization [1, 2] It mostly affects healthy young men, aged 20–40 years and is a diagnosis of exclusion. It has been reported from the United Kingdom, the United States, and Canada in the latter half of 19th and early twentieth century. The reported incidence in India is 1 in 135 ophthalmic patients in a referral ophthalmic center and 1 in 200 to 250 in a general eye hospital [3]. Since it has been classically described as peripheral vasculitis, macular changes have been reported infrequently in literature. Vitrectomy with epiretinal membrane (ERM) peel has been described for ERM in Eales disease [2, 4–8]
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