A Multidisciplinary Approach to the Management of Eales Disease: A Case Report and Review of the Literature

Abstract

Eales disease manifests as an obliterative periphlebitis affecting the retina; it originates from the periphery and progresses posteriorly. It is characterized by retinal vessel wall inflammation, ischemia, and retinal neovascularization. In this report, we present the case of a 34-year-old male who attended our clinic with a sudden blurring of vision in his right eye. A diagnosis of bilateral retinal vasculitis with vitreal hemorrhage was ascertained in his RE. A dilated ocular fundus examination revealed perivenous sheathing of the peripheral vessels in both eyes. Fluorescein angiography indicated dye staining, vessel obliteration, capillary drop-out, areas of non-perfusion and the formation of new vessels. Laboratory tests revealed positive results for Borrelia; a PPD skin test and QuantiFERON TB assay were also positive. The patient underwent bilateral retinal laser pan-photocoagulation, followed by systemic treatment with oral steroids, cephazoline, isoniazid, azathioprine, and entecavir. The steroid dose was progressively reduced over 10 months; the treatment with azathioprine continues, as we are monitoring the patient over the long term. After 3 months, the vasculitis had regressed without any vitreal hemorrhage recurrence. Vision acuity improved from 0.4 to 1 in the patient's right eye. A multidisciplinary approach, which included collaborative management with gastroenterology, infectious disease, pulmonology, and rheumatology specialists, was essential for the diagnosis, treatment, and long-term follow up of the patient.

Keywords: Eales disease; Mycobacterium tuberculosis; epimacular membrane; retinal vasculitis.

Figure 1

Ocular fundus in the right eye of a 34-year-old male patient: (a) central view and (b) periphery details (vitreous hematic cells; epimacular membrane; dilated veins; perivascular sheathing; peripheral focal occlusion; dotted and flame-shaped hemorrhages; and extensive non-perfused areas of the capillaries giving rise to new vessels).

Figure 2

Ocular fundus in the right eye of a 34-year-old male patient: (a) central view and (b) periphery details (epimacular membrane; dilated veins; perivascular sheathing; peripheral focal occlusion; and retinal and preretinal neovascularization).

Figure 3

Fluorescein angiography of the right eye of a 34-year-old male with Eales disease. There were well-delineated areas of non-perfusion in the arterial phase. The early venous phase exhibited staining of the inflamed vessels, hyperfluorescence of the optic disc, and newly formed vessels. We observed leakage at the level of the new vessels and the macula, as well as staining of the vessels during the late phase.

Figure 4

(a) OCT of right eye, revealing thick epimacular membrane with traction; (b) OCT of left eye revealing epimacular membrane.

Figure 5

Right eye (a,b), and left eye (c), revealing resolved vasculitis and new-vessel regression after laser photocoagulation.