Eales disease!
• Disease of retinal vessel wall inflammation leading to obliteration of vessel lumen causing ischemia and neovascularization.
• Young males commonly in the Indian subcontinent
• Presumed immunological reaction in response to an exogenous agent.
• Largely idiopathic.
• Exposure to TB and hypersensitivity to tuberculoprotein mentioned in literature
Pathophysiology
Initially, blood vessels of the retinal periphery get inflamed. This vasculitis manifests as sheathing of blood vessels and leads to obliteration of vessel lumen causing ischemia of that part of the retina perfused by affected blood vessel. VEGF production is increased by persistent ischemia leading to neovascularization. New vessels are fragile and bleed easily leading to recurrent VH.
Vitreous hemorrhages generally resolve in 3 to 6 months. If they persist beyond this duration, the probability of membrane formation increases with increased chances of TRD.
Diagnosis
FFA - leakage of dye surrounding veins indicates active inflammation. Venous staining without leakage indicates sclerosed vessels or resolved inflammation
B scan – detection of RD when VH obscures view of fundus
OCT – for macular involvement
Lab tests - CBC, metabolic panel, ESR, syphilis testing, tuberculin skin testing/QuantiFERON Gold, ANA, ANCA, ACE, lysozyme, urinalysis and CXR
To exclude vascular causes of retinal neovascularization, glucose levels, hemoglobin A1c, hemoglobin electrophoresis and HIV testing should be included.
Treatment
Management depends on the stage of the disease • Corticosteroid (systemic and/or local/periocular) - for the inflammatory stage
• Anti VEGF
• Anti TB treatment – in suspect patients
• Laser photocoagulation – for proliferative stage
• Vitrectomy – for non-clearing VH, tractional RD threatening the macula, multiple vitreous membranes with or without TRD, and combined TRD/RRD
Image from Rajan Eye Care Hospital
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