Adjuvant Intravitreal Bevacizumab for Retinal Neovascularization in Eales' Disease Associated With Latent Mycobacterium Tuberculosis

Abstract

We report a case of bilateral Eales' disease managed with intravitreal bevacizumab. A 32-year-old woman with a history of bacillus Calmette-Guerin vaccine, administered when she was 10 years old, presented with a five-day history of a scotoma in the temporal field of her right eye. A dilated fundus exam and fluorescein angiography showed bilateral retinal peripheral capillary non-perfusion, retinal neovascularization in the right eye, and deep intraretinal hemorrhages in the left eye. Her laboratory workup resulted in a positive QuantiFERON-TB Gold test (Cellestis Ltd, Carnegie, Victoria, Australia). Chest computed tomography showed a calcified granuloma in her right lung. Angiographic-guided pan-retinal photocoagulation was performed, and intravitreal injections of bevacizumab (1.25 mg/0.05 mL) were administered in both eyes over the course of three months. The intraretinal hemorrhages resolved after three months of therapy. Three months following treatment, the patient showed normal fundus findings without any evidence of recurrence and a visual acuity of 20/20 in both eyes. Intravitreal bevacizumab in combination with angiography-guided pan-retinal photocoagulation may be efficacious in select patients with Eales' disease.

Keywords: case report; eales’ disease; intravitreal bevacizumab; photocoagulation; tuberculosis.

Figure 1. Ultra-widefield fundus imaging of the right and left eyes at presentation.

(A) Color photography of the right eye reveals peripheral sheathed vessels (arrow) and an area of retinal neovascularization (arrowhead) along the inferotemporal arcade. (B) Color photography of the left eye reveals sheathed vessels (arrows) and deep intraretinal hemorrhages (asterisk). (C) Fluorescein angiography of the right eye reveals peripheral capillary non-perfusion (asterisk) corresponding with the areas of vascular sheathing and an area of leakage corresponding to the site of retinal neovascularization (arrowheads). (D) Fluorescein angiography of the left eye reveals peripheral capillary non-perfusion (asterisks) corresponding to the areas of vascular sheathing. Fluorescein angiogram of the right (E) and left (F) eyes three months after treatment reveals resolution of the retinal neovascularization in the right eye, resolution of the hemorrhages in the left eye, and no progression of the areas of non-perfusion.