Multimodal approach in the diagnosis and management of Eales disease: a case report
DOI:
https://doi.org/10.13181/mji.cr.247454Keywords:
periphlebitis, rare diseases, retinal vasculitis, vitreous hemorrhageAbstract
Eales disease is a rare idiopathic occlusive retinal vasculitis with low prevalence in the general population. Its infrequent occurrence limits diagnostic and treatment guidelines, emphasizing the need for ongoing reports to establish effective protocols. This case report describes a patient presenting with symptoms of bilateral retinal vasculitis. Fundus examination revealed vitreous hemorrhage (VH) and peripheral retinal vasculitis. Laboratory and imaging tests were performed to exclude differential diagnoses, leading to Eales disease as the primary diagnosis. Pars plana vitrectomy, panretinal laser photocoagulation, intravitreal anti-vascular endothelial growth factor, and anti-tuberculosis therapy were administered. Long-term follow-up showed satisfactory outcomes. This report suggested Eales disease to be a diagnosis of consideration for ophthalmologists encountering male patients with recurrent VH. Clinical suspicion, including appropriate laboratory testing and imaging, is essential to developing a holistic approach to diagnosis and management, aiming to prevent progression and achieve optimal visual outcomes.
Downloads
References
Lee SM, Jung JH, Lee J, Choi EY, Shin JY, Kim M. Clinical features, long-term outcomes, and prognostic factors of Eales' disease in Korean patients. Ocul Immunol Inflamm. 2024;32(5):621−7. https://doi.org/10.1080/09273948.2023.2183870
Murillo López S, Medina Medina S, Murillo López F. Eales' disease: epidemiology, diagnostic and therapeutic concepts. Int J Retina Vitreous. 2022;8(1):3. https://doi.org/10.1186/s40942-021-00354-0
Saxena S, Kumar D. New classification system-based visual outcome in Eales' disease. Indian J Ophthalmol. 2007;55(4):267−9. https://doi.org/10.4103/0301-4738.33038
Biswas J, K R R, Pal B, Gondhale HP, Kharel Sitaula R. Long-term outcomes of a large cohort of patients with Eales' disease. Ocul Immunol Inflamm. 2018;26(6):870−6. https://doi.org/10.1080/09273948.2017.1298817
Rajpal, Singh UB, Mohapatra S, Wagh VK, Porwal C, Kaushik A. Association of Mycobacterium tuberculosis in the causation of Eales' disease: an institutional experience. Indian J Med Microbiol. 2015;33 Suppl:43−5. https://doi.org/10.4103/0255-0857.148829
Singh R, Toor P, Parchand S, Sharma K, Gupta V, Gupta A. Quantitative polymerase chain reaction for Mycobacterium tuberculosis in so-called Eales' disease. Ocul Immunol Inflamm. 2012;20(3):153−7. https://doi.org/10.3109/09273948.2012.658134
Biswas J, Ravi RK, Naryanasamy A, Kulandai LT, Madhavan HN. Eales' disease - current concepts in diagnosis and management. J Ophthalmic Inflamm Infect. 2013;3(1):11. https://doi.org/10.1186/1869-5760-3-11
Davis J, Schecter SH, Sowka J. Eales' disease: the great masquerader. Optometry. 2009;80(7):354−9. https://doi.org/10.1016/j.optm.2008.10.016
Rajurkar K, Thakar M, Gupta P, Rastogi A. Comparison of fundus fluorescein angiography, optical coherence tomography and optical coherence tomography angiography features of macular changes in Eales disease: a case series. J Ophthalmic Inflamm Infect. 2020;10(1):34. https://doi.org/10.1186/s12348-020-00220-4
Cruzado-Sánchez D, Tellez WA, Barriga-Salaverry G, Luglio-Valdivieso H, Luján-Najar S. Wide-field angiography for diagnosis and follow-up of Eales disease: a case series. Arq Bras Oftalmol. 2019;82(4):339−44. https://doi.org/10.5935/0004-2749.20190066
Zhao XY, Cheng SY, Zhang WF, Meng LH, Chen YX. Clinical characteristics of Eales disease and the efficacy of different interventions for neovascular complications. Retina. 2022;42(10):1975−88. https://doi.org/10.1097/IAE.0000000000003534
Youssef J, Novosad SA, Winthrop KL. Infection risk and safety of corticosteroid use. Rheum Dis Clin North Am. 2016;42(1):157−76, ix−x. https://doi.org/10.1016/j.rdc.2015.08.004
Mehboob MA, Tahir M, Batool H. Role of intravitreal bevacizumab in management of Eale's disease. Pak J Med Sci. 2018;34(2):333−7. https://doi.org/10.12669/pjms.342.14483
Chanana B, Azad RV, Patwardhan S. Role of intravitreal bevacizumab in the management of Eales' disease. Int Ophthalmol. 2010;30(1):57−61. https://doi.org/10.1007/s10792-009-9292-0
Hsia NY, Lin CJ, Lai CT, Bair H, Chang CH, Lin JM, et al. Intravitreal aflibercept as a rescue therapy for retinal neovascularization and macular edema due to Eales disease. Case Rep Ophthalmol Med. 2021;2021:8887362. https://doi.org/10.1155/2021/8887362
Ersöz MG, Hocaoğlu M, Sayman Muslubaş IB, Arf S, Karaçorlu M. Vitrectomy due to vitreous hemorrhage and tractional retinal detachment secondary to Eales' disease. Turk J Ophthalmol. 2021;51(2):102−6. https://doi.org/10.4274/tjo.galenos.2020.43709
Venkateswaran N, Dave SB, Flynn Jr HW. Eales disease: a blast from the past. Retin Physician. 2018;15:39-43.
Oehlers SH, Cronan MR, Beerman RW, Johnson MG, Huang J, Kontos CD, et al. Infection-induced vascular permeability aids Mycobacterial growth. J Infect Dis. 2017;215(5):813−7. https://doi.org/10.1093/infdis/jiw355
Lee SM, Jung JH, Lee J, Choi EY, Shin JY, Kim M. Clinical features, long-term outcomes, and prognostic factors of Eales' disease in Korean patients. Ocul Immunol Inflamm. 2024;32(5):621−7. https://doi.org/10.1080/09273948.2023.2183870
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Gitalisa Andayani Adriono, Sausan Rasyid Mahfudz, Ichsan Fauzi Triyoga
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who publish with Medical Journal of Indonesia agree to the following terms:
- Authors retain copyright and grant Medical Journal of Indonesia right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial License that allows others to remix, adapt, build upon the work non-commercially with an acknowledgment of the work’s authorship and initial publication in Medical Journal of Indonesia.
- Authors are permitted to copy and redistribute the journal's published version of the work non-commercially (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in Medical Journal of Indonesia.
