Abstract
BackgroundTo describe the epidemiological traits, clinical characteristics, diagnostic procedures, therapeutic interventions and evolution in a large series of patients with diagnosis of Eales’ disease.MethodsA clinical retrospective review of patients with Eales’ disease, evaluated and treated between April 2009 and April 2018, with a 1-year minimum follow-up. Thirty patients (59 eyes), were included. Age, sex, laboratory results (CBC, glycemia, protein electrophoresis, ACE levels) immunological profile and a Quantiferon-TB Gold Plus test were recorded. The patients were divided into groups according to their evolution, medical or surgical treatment, and visual outcomes.ResultsSeventeen male patients and 13 female patients were included, and their ages ranged from 14 to 35 years. The Quantiferon-TB Gold Plus test was positive in 25 patients. Twenty-eight patients had unilateral vitreous hemorrhage, 10 of whom presented with vasculitis and non-perfusion areas in the contralateral eye, 9 presented contralateral peripheral neovascularization and 9 had contralateral fibrovascular proliferation. The remaining 2 patients presented with a rhegmatogenous retinal detachment. In 6 patients, conservative treatment with intravitreal anti-VEGF injections and photocoagulation was performed after the hemorrhage cleared. Twenty-two patients, required vitrectomy, with good visual outcomes. Macular edema was found in 16 eyes, which responded to periocular and/or systemic corticosteroid therapy, except for 9 eyes that required intravitreal bevacizumab, with complete resolution in 7 eyes and partial resolution in 2 eyes.ConclusionsEales’ disease is a pathology of significant prevalence in our country. The distribution according to sex, tends to be equivalent. The etiology, even when it is not specifically determined, according to laboratory tests, confirms the probable immunologic response in the presence of Mycobacterium tuberculosis antigens. This is still a diagnosis of exclusion, and therefore, it is advisable to perform a complete laboratory work-up in each case. Timely application of laser and other medical treatments, help to avoid progression to more advanced stages and their complications. The surgical treatment of vitrectomy for vitreous hemorrhage, and/or tractional vitreous detachment yields good primary anatomical and functional outcomes. Secondary macular edema responds to periocular and intravitreal corticosteroids, and in refractory cases, the use of anti-VEGF therapy leads to an effective resolution.
Highlights
To describe the epidemiological traits, clinical characteristics, diagnostic procedures, therapeutic interventions and evolution in a large series of patients with diagnosis of Eales’ disease
The epidemiology of this disease in Latin America has not been reported. It constitutes a pathology of significant frequency, comparable with that of other countries. This epidemiologic finding becomes relevant considering the significant prevalence in populations of different racial origins, suggesting that-genetic makeup does not determine the etiology, or the development of the disease, and reinforcing instead the most accepted theory that links the origin of this vasculopathy with an abnormal immunologic response to the antigenic fragments of Mycobacterium tuberculosis [2, 3, 6]
Despite the advanced stages of these patients, the evolution is favorable if treated in a timely manner, because it lacks other components that could exacerbate the process, such as those of diabetes. Even though they share similar clinical and evolutionary characteristics, the behavior of Eales’ disease is less aggressive than that of proliferative diabetic retinopathy. We found this phenomenon even in cases with large areas of non-perfusion and/or aggressive neovascularization, probably because Eales’ pathology does not originate from a systemic metabolic disorder, or permanent endothelial dysfunction such as diabetic retinopathy [10]
Summary
To describe the epidemiological traits, clinical characteristics, diagnostic procedures, therapeutic interventions and evolution in a large series of patients with diagnosis of Eales’ disease. Eales’ disease, constitutes an idiopathic occlusive retinal vasculopathy apparently multifactorial, and with a likely immunologic origin, which mainly affects the peripheral retina bilaterally in young patients predominantly males [1, 2]. Inflammatory, vascular and potentially ischemic nature—generating extensive areas of nonperfusion and resulting neovascularization, as well as changes in the structure of the vitreous and its interaction with the retina, are responsible for its wide range of clinical manifestations depending on the evolution of the process. In its evolution we can find vitreous hemorrhages, macular edema, tractional retinal detachments, and less frequently, secondary rhegmatogenous or mixed RD, as well as secondary neovascular glaucoma. Different therapeutic interventions, including pharmacological therapy, laser and/or surgery have been reported, and they are used independently or in combination according to the patient’s needs, and determined by the specific clinical situation
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