Ultra-wide field angiography in the management of Eales disease

Abstract

Aims: This study aims to evaluate the use of ultra-wide field (UWF) angiography in patients with Eales disease (ED).

Settings and design: Prospective observational case series in tertiary eye care center.

Subjects and methods: This study involved 17 patients diagnosed with ED, who underwent UWF fluorescein angiography. The angiograms were analyzed to look for additional information as compared to Early Treatment Diabetic Retinopathy Study seven standard field. The impact of this information in the management of patients was analyzed.

Results: 24 eyes of 17 patients with mean age of 26.3 years were diagnosed with ED and underwent UWF angiography. UWF fluorescein angiography was helpful in the documentation of peripheral retinal changes (in 67% of eyes), exact localization of capillary nonperfusion (CNP) (in 54% of eyes), and in determination of vascular involvement (in 21% of eyes). In 33% of eyes, immediate treatment plan changed because of changes picked up on UWF angiography.

Conclusions: UWF angiography helped in the better documentation, exact quantification, and location of CNP areas and better determination of disease activity. UWF imaging may play an important part in the management of patients with ED.

Figure 1

Ultra-wide field pseudo-color image (a) of right eye showing active vasculitis with intra-retinal hemorrhages temporally (arrows). Ultra-wide field angiography (b) showed widespread active peripheral vasculitis with vascular leakage. Note unaffected vessels at the posterior pole apart from disc leakage, which indicates active vasculitis. There are areas of capillary nonperfusion and micro vascular abnormalities. Ultra-wide field pseudo-color image after steroid therapy (c) shows resolution of active vasculitis (blue arrow). Healed vasculitis is seen as sheathing (arrow heads)

Figure 2

Ultra-wide field pseudo-color image of the right eye (a) of patient with Eales disease showing temporal sea fan neovascularization (blue arrow) and nasal area of sclerosed vessels. Ultra-wide field angiography (b) confirmed temporal sea fan neovascularization along with capillary nonperfusion areas anterior to it. In addition, area of healed vasculitis was confirmed and a neovascularization were picked in nasal periphery (arrow head), which were not seen clinically

Figure 3

Ultra-wide field angiography of the right eye of a patient with Eales disease showing extensive vascular involvement, peripheral ischemia, and collateral formation (a). The laser photocoagulation has been done, but is inadequate leading to persistence of neovascularization of the disc. Targeted laser treatment resulted in prompt resolution of neovascularization of the disc (b)

Figure 4

Ultra-wide field angiography of fellow (left) eye of a patient with Eales disease. Though clinically the eye seemed uninvolved, on ultra-wide field angiography a small area of micro vascular abnormalities and nonperfusion (blue arrow) is detected in far periphery indicating that the disease is bilateral