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Cocaine Abuse as an Immunological Trigger in a Case Diagnosed with Eales Disease. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59010169. [PMID: 36676793 PMCID: PMC9865688 DOI: 10.3390/medicina59010169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/10/2023] [Accepted: 01/13/2023] [Indexed: 01/17/2023]
Abstract
Background: Eales disease is a clinical syndrome affecting the mid-peripheral retina with an idiopathic occlusive vasculitis and possible subsequent retinal neovascularization. The disease can develop into visually threatening complications. Case Presentation: We report the case of a 40-year-old Caucasian male with a history of cocaine abuse who presented with blurred vision in the left eye (LE). Fundus examination showed vitreous hemorrhages, peripheral sheathing of venous blood vessels, areas of retinal neovascularization in the LE, and peripheral occlusive phlebitis in the right eye. The full serologic panel was negative except for the heterozygous mutation of factor V Leiden. Clinical and biochemical parameters suggested a diagnosis of Eales disease. Therapy with dexamethasone, 1 mg per kg per day, tapered down slowly over 4 months, and peripheral laser photocoagulation allowed a regression of clinical signs and symptoms. Conclusion: This case shows an uncommon presentation of Eales disease associated with cocaine abuse. Both cocaine abuse and a thrombophilic pattern, as cofactors, might have sensitized the retinal microcirculation on the pathogenetic route to this retinal pathology. Furthermore, in view of this hypothesis, a thorough ocular and general medical history investigating drug abuse and coagulation disorders is recommended for ophthalmologists in such cases.
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Kelgaonkar A, Govindhari V, Khalsa A, Basu S. Anti-tubercular therapy alone for treatment of isolated tubercular retinal vasculitis. Eye (Lond) 2022; 36:1777-1782. [PMID: 34373615 PMCID: PMC9391439 DOI: 10.1038/s41433-021-01727-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 07/13/2021] [Accepted: 07/28/2021] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To compare the time to resolution of perivascular infiltrates in tubercular retinal vasculitis (TRV) between anti-tubercular therapy (ATT) alone, and in combination with systemic corticosteroids. METHODS Observational retrospective cohort study in a tertiary eye centre in eastern India. Patients with TRV who were treated with anti-tubercular therapy (ATT) alone (Group A), or in combination with systemic corticosteroids (Group B) were included in the study. Eyes with additional inflammatory signs (cystoid macular oedema, vitritis ≥2+, optic disc oedema) were excluded. Resolution was defined as complete disappearance of perivascular infiltrates on seven-field fundus photographs. Descriptive statistics were used for demographic data. A linear mixed effects model was applied to adjust for intereye correlations, in patients with bilateral disease. The primary outcome measure was time to resolution of perivascular infiltrates. Secondary outcome measure was need for laser or surgical intervention for management of complications of TRV. RESULTS Fifty eyes of 39 patients (Group A 21/18 and Group B 29/21) were included. Both groups had similar demographics and severity of vasculitis. All patients had complete resolution of TRV. On adjusting for intereye correlation, the mean difference in time to resolution between the two groups (Group A, 3.24 [95% CI 2.69-3.77] months, and Group B, 4.76 [95% CI 3.52-5.99] months) was not statistically significant (0.96 weeks [-0.52 to 2.45] p = 0.21). Vaso-occlusive complications and healing patterns were similar in both groups. CONCLUSIONS ATT alone, may be sufficient for resolution of perivascular infiltrates, in TRV without additional inflammatory signs.
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Affiliation(s)
- Anup Kelgaonkar
- L V Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, India
| | - Vishal Govindhari
- L V Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, India
- Pushpagiri Vitreoretina Institute, West Maredpally, Secunderabad, India
| | - Ashish Khalsa
- L V Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, India
| | - Soumyava Basu
- L V Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, India.
- L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India.
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Abd ZA. Tuberculosis of the eye, case series study. J Med Life 2022; 15:1058-1062. [PMID: 36188648 PMCID: PMC9514815 DOI: 10.25122/jml-2021-0343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/10/2022] [Indexed: 11/21/2022] Open
Abstract
Tuberculosis of the eye represents a challenge throughout the world, and there is a continuous debate about its pathophysiology, diagnosis, and treatment. The present research represents an interventional prospective study focusing on the variable clinical presentations, and the diagnostic and therapeutic characteristics of ocular tuberculosis. Fifteen eyes from nine cases were diagnosed with ocular tuberculosis, treated, and followed up between 2010 and 2020. The diagnosis was based on (1) a compatible clinical picture, (2) highly positive Tuberculin skin test or a positive IGRA test (Interferon-Gamma Release Assays), (3) a dramatic response to anti-tuberculous drugs without systemic steroid. Mean age was 41.22±13.64 years; eight cases were females 89.8%, one male 11.1%. Only one case had preexisting pulmonary tuberculosis. Bilateral ocular involvement occurred in two thirds of cases (66.7%). The most common clinical presentation was intermediate uveitis (33.3%), followed by multifocal choroiditis (20%). All cases were cured without relapse for the 2–10 years of follow-up, after taking oral anti-tuberculous drugs for 6–12 months. No systemic steroids were given, only topical steroid drops, as indicated. In conclusion, ocular tuberculosis is a mysterious condition with a wide-range of clinical presentations and should be considered in the differential diagnoses of any type of intraocular inflammation, or any unexplained reduction in vision. Oral anti-tuberculous drugs with or without topical steroids are sufficient to improve vision, produce, cure, and prevent relapse.
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Affiliation(s)
- Zeena Adnan Abd
- Surgery Department, Ophthalmology Unit, School of Medicine, Al-Nahrain University, Baghdad, Iraq,Corresponding Author: Zeena Adnan Abd, Surgery Department, Ophthalmology Unit, School of Medicine, Al-Nahrain University, Baghdad, Iraq. E-mail:
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Clinical Manifestations and Outcomes of Tubercular Uveitis in Taiwan—A Ten-Year Multicenter Retrospective Study. Medicina (B Aires) 2022; 58:medicina58030376. [PMID: 35334552 PMCID: PMC8950060 DOI: 10.3390/medicina58030376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 02/24/2022] [Accepted: 03/01/2022] [Indexed: 11/17/2022] Open
Abstract
Background andObjectives: This 10-year multicenter retrospective study reviewed the clinical manifestations, diagnostic tests, and treatment modalities of tubercular uveitis (TBU), including direct infection and indirect immune-mediated hypersensitivity to mycobacterial antigens in Taiwan. Materials and Methods: This retrospective chart review of patients with TBU was conducted at 11 centers from 1 January 2008 to 31 December 2017. We used a multiple regression model to analyze which factors influenced best-corrected visual acuity (BCVA) improvement. Results: A total of 79 eyes from 51 patients were included in the study. The mean age was 48.9 ± 16.4 years. The mean change of LogMAR BCVA at last visit was −0.21 ± 0.45. Diagnostic tools used include chest X-ray, chest computed tomography, Mantoux test, interferon gamma release test (QuantiFERON-TB Gold test), intraocular fluid tuberculosis polymerase chain reaction, and bronchial alveolar lavage. The clinical manifestations included 48% posterior uveitis and 37% panuveitis. In the sample, 55% of the cases were bilateral and 45% unilateral. There was 60.76% retinal vasculitis, 35.44% choroiditis, 21.52% serpiginous-like choroiditis, 17.72% vitreous hemorrhage, 12.66% posterior synechiae, 6.33% retinal detachment, and 3.80% choroidal granuloma. Treatment modalities included rifampicin, isoniazid, pyrazinamide, ethambutol, oral steroid, posterior triamcinolone, non-steroidal anti-inflammatory drugs, vitrectomy, and immunosuppressants. BCVA improved in 53.2% of eyes and remained stable in 32.9% of eyes. In the final model of multiple regression, worse initial BCVA, pyrazinamide, and receiving vitrectomy predicted better BCVA improvement. Ethambutol was associated with worse visual outcomes. Seven eyes experienced recurrence. Conclusions: This is the largest 10-year multicenter retrospective study of TBU in Taiwan to date, demonstrating the distribution of clinical manifestations and clinical associations with better treatment outcomes. The study provides a comprehensive description of TBU phenotypes in Taiwan and highlights considerations for the design of further prospective studies to reliably assess the role of ATT and vitrectomy in patients with TBU.
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Eales' Disease: When the Rare Sounds Frequent. Case Rep Ophthalmol Med 2021; 2021:1056659. [PMID: 34422421 PMCID: PMC8371666 DOI: 10.1155/2021/1056659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/22/2021] [Indexed: 11/17/2022] Open
Abstract
Eales' disease is a peripheral occlusive retinal phlebitis, with an unclear pathogenesis. The classic association with hypersensitivity to Mycobacterium tuberculosis protein infers that immunologic disturbance may be involved. Here, we described three cases of Eales' disease. All patients are Caucasian men aged 27-58 years and presented with vitreous hemorrhage and/or peripheral venous vasculitis. Tuberculin skin sensitive test (Mantoux screening test) and interferon-gamma release assay (IGRA) were positive in all patients. Therapeutic approach included antituberculosis therapy and systemic steroids, associated or not to immunosuppressive therapy, and retinal scatter photocoagulation in all cases. Antivascular endothelial grow factor (VEGF) intravitreal injections were also required in two cases. Since various retinal diseases can resemble this presentation, Eales' disease is considered a diagnosis of exclusion. Early diagnosis and appropriate therapeutic approach are both essential to accomplish disease control and reduce ophthalmologic complications.
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Bansal R, Moharana B, Katoch D, Gupta V, Dogra MR, Gupta A. Outcome of pars plana vitrectomy in patients with retinal detachments secondary to retinal vasculitis. Indian J Ophthalmol 2021; 68:1905-1911. [PMID: 32823412 PMCID: PMC7690542 DOI: 10.4103/ijo.ijo_551_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose: Retinal detachments (RD) secondary to retinal vasculitis are highly complex. We report the clinical profile and outcome of vitrectomy in RDs secondary to retinal vasculitis in terms of intraoperative findings, final anatomical, and functional outcome. Methods: In a retrospective review of 68 patients (6 with bilateral RD; 74 eyes) undergoing pars plana vitrectomy (PPV) between 2000 and 2015 for vasculitic RD, tractional RD was present in 50 (67.57%) eyes and combined RD in 24 (32.43%) eyes. Results: The mean age was 31.54 ± 9.95 years (62 males, 6 females). Fibrovascular proliferations (FVPs) involved major vascular arcades (22.98%), optic disc (10.81%), both arcades and disc (20.27%), peripheral retina (32.43%), and arcades with peripheral retina (13.51%). A total of 14 (18.92%) eyes had retinal folds, of which 9 had macular drag. Of 24 eyes with combined RD, 3 (12.5%) eyes had macular hole, 15 (62.5%) eyes had the primary retinal break anterior to equator, and 6 (25%) eyes had the primary break posterior to equator. Twenty-one (28.38%) eyes had iatrogenic retinal breaks. Thirty-eight (51.35%) eyes required an internal tamponade [gas in 31 (81.57%) eyes and silicon oil in seven (18.42%) eyes]. A scleral buckle was additionally required in 26 (35.14%) eyes. Postoperative complications included vitreous hemorrhage (27.03%), re-RD (12.16%), and iris neovascularization (9.46%). The median follow-up was 18 months (range 6-122 months). Sixty-eight (91.9%) eyes achieved final anatomical success. Fifty-two (70.27%) eyes had ≥2 lines visual improvement. Conclusion: Vasculitic RDs are complicated by tractional/combined RDs, peripherally located FVPs, retinal folds and iatrogenic retinal breaks, and carry a moderate prognosis.
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Affiliation(s)
- Reema Bansal
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Bruttendu Moharana
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deeksha Katoch
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishali Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mangat R Dogra
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amod Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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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; 51:102-106. [PMID: 33951898 PMCID: PMC8109032 DOI: 10.4274/tjo.galenos.2020.43709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives To investigate visual and anatomical outcomes of vitreoretinal surgeries in patients with Eales' disease. Materials and Methods In this retrospective study, 22 eyes of 21 patients with vitreous hemorrhage (VH) or tractional retinal detachment (TRD) secondary to Eales' disease who underwent vitreoretinal surgery between January 1997 and December 2015 and had at least 1 year of follow-up were included. Results The mean best corrected visual acuity (BCVA) was significantly higher at final visit (0.6±0.9 logMAR) than the preoperative values (1.8±1.1 logMAR) (p<0.001). After surgery, BCVA was stable in 4 eyes (18.2%), increased in 16 eyes (72.7%), and decreased in 2 eyes (9.1%). Although the mean BCVA was better in the VH group (0.3±0.34 logMAR) than the TRD group (0.9±1.1 logMAR), the difference was not statistically significant (p=0.1). Multivariable linear regression analyses revealed that final BCVA was negatively associated with preoperative or postoperative proliferative vitreoretinopathy grade C (PVR-C), preoperative retinal detachment involving the macula, postoperative neovascular glaucoma, and long preoperative duration of disease, and positively associated with preoperative BCVA. Final BCVA was not associated with preoperative retinal and disc neovascularization, rubeosis iridis, total posterior hyaloid detachment, preoperative retinal laser photocoagulation, indication of surgery, diameter of sclerotomy (20 or 23 gauge), preoperative lens status, preoperative or postoperative epimacular membrane, peroperative iatrogenic retinal breaks, postoperative hypotony, cystoid macular edema, and new or recurrent retinal detachment. The primary anatomic success rate was 81.8% and the final anatomic success rate was 90.9%. Conclusion In Eales' disease, good visual results can be obtained with vitreoretinal surgery if the detachment area does not involve the macula and PVR-C does not develop pre- or postoperatively.
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Affiliation(s)
| | | | | | - Serra Arf
- İstanbul Retina Institute, İstanbul, Turkey
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Gong Y, Wei S, Zhang M, Jin X, Hou B, Wang D. Serum interferon‐gamma/interleukin‐4 imbalance in patients with Eales' disease. Clin Exp Optom 2021; 93:228-32. [PMID: 20533927 DOI: 10.1111/j.1444-0938.2010.00482.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Yan Gong
- Department of Ophthalmology, General Hospital of Chinese PLA, Beijing, China
- Department of Ophthalmology, Armed Police General Hospital, Beijing, China E‐mail:
| | - Shi‐hui Wei
- Department of Ophthalmology, General Hospital of Chinese PLA, Beijing, China
| | - Mao‐nian Zhang
- Department of Ophthalmology, General Hospital of Chinese PLA, Beijing, China
| | - Xin Jin
- Department of Ophthalmology, General Hospital of Chinese PLA, Beijing, China
| | - Bao‐ke Hou
- Department of Ophthalmology, General Hospital of Chinese PLA, Beijing, China
| | - Dan Wang
- Department of Ophthalmology, Armed Police General Hospital, Beijing, China E‐mail:
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Takhchidi K, Takhchidi NK, Kasmynina TA, Tebina EP, Mokrunova MV. Retinal laser photocoagulation in management of eales' disease. BULLETIN OF RUSSIAN STATE MEDICAL UNIVERSITY 2020. [DOI: 10.24075/brsmu.2020.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Eales’ disease is an idiopathic occlusive inflammatory vasculopathy resulting in peripheral retinal ischemia, neovascularization, recurrent hemophthalmos, and proliferative tissue formation. It is often complicated by tractional retinal detachment, secondary glaucoma, and central retinal vein occlusion. The management of patients with Eales’ disease includes mainly glucocorticosteroid therapy, the use of angiogenesis inhibitors, vitreoretinal surgery and laser photocoagulation. The clinical case reported demonstrates the potential of retinal laser photocoagulation for treatment of the Eales’ disease in the ischemic and proliferative stages. The results of retinal laser photocoagulation used as monotherapy demonstrate the clinical and functional indices improvement: enhanced visual acuity, stabilized central retinal sensitivity value, restored clarity to the ocular media, regression of neovascularization and macular edema in the patient’s eye being in the proliferative (3b) stage, and the process stabilization in the eye being in the ischemic (2a) stage of the disease.
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Affiliation(s)
- KhP Takhchidi
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - NKh Takhchidi
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - TA Kasmynina
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - EP Tebina
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - MV Mokrunova
- Pirogov Russian National Research Medical University, Moscow, Russia
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THE COLLABORATIVE OCULAR TUBERCULOSIS STUDY (COTS)-1: A Multinational Review of 251 Patients With Tubercular Retinal Vasculitis. Retina 2020; 39:1623-1630. [PMID: 29697588 DOI: 10.1097/iae.0000000000002194] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE Tubercular retinal vasculitis (TRV) is a heterogeneous disease that can be difficult to manage because of nonspecific presentation and limitations of confirmatory tests for tuberculosis. This is a big data analysis on phenotypes and treatment outcomes for TRV. METHODS Multicentre retrospective study of patients with TRV between January 2004 and December 2014 and a minimum follow-up of 1 year. RESULTS Two hundred and fifty-one patients with TRV with a mean age of 38.9 ± 14.4 years (range, 9-86 years) were included. The patients were predominantly males (n = 167/251; 66.5%) of Asian ethnicity (n = 174/246; 70.7%), and geographical origin (n = 137/251; 54.6%). Most patients had features of occlusive type of RV (n = 113/185; 61.1%) except Caucasians (n = 11; 28.2%). There was no significant difference in treatment failure whether patients received antitubercular therapy (ATT) (P = 0.29), although treatment failure was less frequent in patients who received ATT (13.6%; n = 31/228) compared with those who did not (21.7%, n = 5/23). Less treatment failures were observed in patients with occlusive type RV who received ATT; however, this was not significant on survival analysis (P = 0.09). Treatment with ATT was associated with higher failure rates in patients of Hispanic and African American race and those with TRV associated with panuveitis (compared with posterior uveitis). CONCLUSION In this multinational study of TRV, there was no significant therapeutic effect of ATT. However, a definitive conclusion about the role of ATT could not be made because of a few patients who did not receive ATT. Because this is a retrospective study with a limited 1-year follow-up, the effect of ATT may have been overestimated (or underestimated) in the duration of follow-up.
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Traitement des uvéites intermédiaires, postérieures et panuvéites non infectieuses. J Fr Ophtalmol 2020; 43:341-361. [DOI: 10.1016/j.jfo.2019.03.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/02/2019] [Accepted: 03/28/2019] [Indexed: 01/01/2023]
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Majumder PD, Sitaula RK, Biswas J. Pediatric Eales Disease: An Indian Tertiary Eye Center Experience. J Pediatr Ophthalmol Strabismus 2018; 55:270-274. [PMID: 29709043 DOI: 10.3928/01913913-20180213-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 09/21/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To report the clinical profiles, etiologies, treatment modalities, and outcomes for Eales disease in patients younger than age 16 years in India. METHODS Retrospective review of medical records of patients with Eales disease who had a minimum 5-year follow-up period. RESULTS A total of 25 eyes of 13 patients were included. Of these 13 patients, 12 (94%) had bilateral Eales disease and 11 (84.6%) were men. Mean patient age was 14.1 years (range: 11 to 16 years). Diminution of vision (36%) was the most common presenting complaint, followed by both diminutions of vision and floaters (32%). Sclerosed vessels were seen in all eyes, and 21 (84%) eyes had active periphlebitis at presentation. Neovascularization elsewhere was seen in 20 (80%) eyes and neovascularization of the optic disc was seen in 1 (4%) eye. Veno-venous shunts were found in 12 (48%) eyes, and 18 (72%) eyes had vitreous hemorrhage. All eyes received photocoagulation; 84.6% of patients received oral steroids, with 7.7% of patients treated with azathioprine and 38.4% treated with anti-tubercular therapy. Vitrectomy was performed in 36% of eyes for non-clearing vitreous hemorrhage and tractional retinal detachment. Vision improved in 7 (28%) eyes, was stable in 12 (48%) eyes, and worsened in 6 (24%) eyes. Recurrence of the disease more than five times during the 5-year follow-up period occurred in 20% of patients. CONCLUSIONS Recurrent vasculitis and vitreous hemorrhage in children should raise the suspicion of pediatric Eales disease. [J Pediatr Ophthalmol Strabismus. 2018;55(4):270-274.].
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Presumed tuberculous uveitis in a university-based tertiary referral center in Saudi Arabia. Int Ophthalmol 2018; 39:317-333. [DOI: 10.1007/s10792-017-0815-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 12/15/2017] [Indexed: 11/26/2022]
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Sriboonnark T, Boonsopon S, Tesavibul N, Leeamornsiri S, Choopong P. Intravitreal bevacizumab in treatment of retinal neovascularization from tuberculous retinal vasculitis. Int J Ophthalmol 2017; 10:1627-1629. [PMID: 29062788 DOI: 10.18240/ijo.2017.10.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 07/27/2017] [Indexed: 11/23/2022] Open
Affiliation(s)
- Theeratach Sriboonnark
- Department of Ophthalmology, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Sutasinee Boonsopon
- Department of Ophthalmology, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Nattaporn Tesavibul
- Department of Ophthalmology, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Supinda Leeamornsiri
- Department of Ophthalmology, Thammasat University Hospital, Pathumthani 12120, Thailand
| | - Pitipol Choopong
- Department of Ophthalmology, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
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Ng KK, Nisbet M, Damato EM, Sims JL. Presumed tuberculous uveitis in non-endemic country for tuberculosis: case series from a New Zealand tertiary uveitis clinic. Clin Exp Ophthalmol 2017; 45:357-365. [DOI: 10.1111/ceo.12881] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 10/19/2016] [Accepted: 11/23/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Ken K Ng
- Ophthalmology Department; Greenlane Clinical Centre; Auckland New Zealand
| | - Mitzi Nisbet
- Infectious Disease Department; Auckland City Hospital; Auckland New Zealand
| | - Erika M Damato
- Ophthalmology Department; Greenlane Clinical Centre; Auckland New Zealand
| | - Joanne L Sims
- Ophthalmology Department; Greenlane Clinical Centre; Auckland New Zealand
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Abstract
PURPOSE To evaluate the efficacy of systemic infliximab for the induction of remission in patients with retinal vasculitis, inadequately responsive to other immunomodulatory therapy, based on fluorescein angiography grading for retinal vasculitis evaluation. METHODS We analyzed 60 patients with retinal vasculitis, from the Massachusetts Eye Research and Surgery Institution in Cambridge, MA. Response to therapy was based on analysis of serial fluorescein angiography and fundus photography, including a baseline angiogram before initiation of infliximab. RESULTS Sixty patients received infliximab therapy between July 2007 and July 2012 at Massachusetts Eye Research and Surgery Institution for a diagnosis of retinal vasculitis. All had previously showed a poor clinical response to other immunomodulatory regimens, or ceased therapy due to intolerable side effects. The initial dose of infliximab was 5 mg/kg in all patients and remained at this dose for the extent of treatment in 57 (95%) patients. At 6 months, 45 of 51 (88.23%) patients were maintaining remission with therapy, 5 (9.8%) were in partial remission, and 1 patient had failed. At 12 months, 39 of 39 (100%) patients were maintaining remission with therapy. CONCLUSION Infliximab is effective for the treatment of recalcitrant noninfectious retinal vasculitis, refractory to conventional immunomodulatory therapy.
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Abstract
The syndrome of recurrent vitreous hemorrhages in young men was described for the first time by Henry Eales in 1880. The association with a clinical manifestation of ocular inflammation was reported 5years later. Eales disease affects young adults who present with ischemic retinal vasculitis, with the peripheral retina most commonly affected. Most cases have been reported in South Asia. Although the etiology of this abnormality is unknown, it may be related to an immune sensitivity to Mycobacterium tuberculosis antigens. Its pathogenesis is related to extensive ischemia that affects the retina, secondary to an obliterative retinal vasculopathy with release of angiogenic factors of the VEGF type. Involvement of the retina is the hallmark of the disease, which manifests as follows: periphlebitis, retinal capillary ischemia most often affecting the periphery with secondary proliferative retinopathy and retinal and/or papillary neovascularization, recurrent vitreous hemorrhages and tractional retinal detachment. These complications are potentially blinding. The natural history of Eales disease varies, with temporary or permanent remission in some cases and continuous progression in others. Progression is often bilateral, which necessitates regular follow-up. The treatment of Eales disease depends on the stage of the disease and is not well defined. Observation only, pars plana vitrectomy surgery and/or intravitreal injections of anti-VEGF are recommended in cases of vitreous hemorrhage, associated with corticosteroids when retinal vasculitis is present. Laser pan-retinal photocoagulation is necessary when neovascularization is present.
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Abstract
AIMS To determine if characteristics of retinal vasculitis correlate with ocular complications, or the response to different lines of treatment. MATERIALS AND METHODS We performed a computerised database analysis of 56 patients evaluated for uveitis at the Casey Eye Institute from September 1985 until May 2010. All patients had non-infectious retinal vasculitis and at least 1 year of follow-up. RESULTS Although occlusive vasculitis was rare, retinal neovascularisation occurred much more commonly in the occlusive vasculitis subgroup than among the non-occlusive vasculitis subgroup (p<0.01). Epiretinal membrane (ERM) was found more commonly in the retinal vasculitis patients who presented with cotton wool spots and intraretinal haemorrhage compared to retinal vasculitis patients who presented with sheathing noted on clinical examination (p<0.01). Smoking was significantly related to vision loss. Age at presentation below 40 years correlated with therapy beyond oral corticosteroids CONCLUSIONS The heterogeneity of retinal vasculitis should be considered in providing prognostic information. Neovascularisation occurs more commonly in occlusive retinal vasculitis, and ERM is diagnosed more frequently in conjunction with cotton wool spots and intraretinal haemorrhage rather than just vascular sheathing. Cigarette use predicts visual loss and patients who are relatively young often receive treatment beyond oral corticosteroids.
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Affiliation(s)
- Amro Ali
- Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA
| | - Jennifer H Ku
- Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Eric B Suhler
- Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, Oregon, USA Portland Veterans Affairs Medical Center, Portland, Oregon, USA
| | - Dongseok Choi
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - James T Rosenbaum
- Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon, USA Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA Devers Eye Institute, Legacy Health Systems, Portland, Oregon, USA
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Biswas J, Ravi RK, Naryanasamy A, Kulandai LT, Madhavan HN. Eales' disease - current concepts in diagnosis and management. J Ophthalmic Inflamm Infect 2013; 3:11. [PMID: 23514227 PMCID: PMC3605068 DOI: 10.1186/1869-5760-3-11] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 11/27/2012] [Indexed: 12/14/2022] Open
Abstract
Eales' disease, first described by the British ophthalmologist Henry Eales in 1880, is characterized by three overlapping stages of venous inflammation (vasculitis), occlusion, and retinal neovascularization. Diagnosis is mostly clinical and requires exclusion of other systemic or ocular conditions that could present with similar retinal features. In recent years, immunological, molecular biological, and biochemical studies have indicated the role of human leukocyte antigen, retinal autoimmunity, Mycobacterium tuberculosis genome, and free radical-mediated damage in the etiopathogenesis of this disease. However, its etiology appears to be multifactorial. The management depends on the stage of the disease and consists of medical treatment with oral corticosteroids in the active inflammatory stage and laser photocoagulation in the advanced retinal ischemia and neovascularization stages.
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Affiliation(s)
- Jyotirmay Biswas
- Department of Uveitis and Ocular Pathology, Vision Research Foundation, Sankara Nethralaya, No. 41, College Road, Nungambakkam, Chennai, 600006, India
| | - Reesha Karingattil Ravi
- Little Flower Hospital and Research Centre, P.O. Box No. 23, Angamaly Kochi, Kerala, 683572, India
| | - Angayarkanni Naryanasamy
- Biochemistry Department, Vision Research Foundation, Sankara Nethralaya, No. 41, College Road, Nungambakkam, Chennai, 600006, India
| | - Lily Therese Kulandai
- Department of Microbiology and Molecular Biology, Vision Research Foundation, Sankara Nethralaya, No. 41, College Road, Nungambakkam, Chennai, 600006, India
| | - Hajib Naraharirao Madhavan
- Department of Microbiology and Molecular Biology, Vision Research Foundation, Sankara Nethralaya, No. 41, College Road, Nungambakkam, Chennai, 600006, India
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CP J, AL G, JD L. Combination of intravitreal bevacizumab and peripheral photocoagulation: an alternative treatment in eales disease. MEDICAL HYPOTHESIS, DISCOVERY & INNOVATION OPHTHALMOLOGY JOURNAL 2013; 2:30-4. [PMID: 24600639 PMCID: PMC3939753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To report the efficacy of combination therapy (bevacizumab and photocoagulation) in a case of Eales Disease this study has been performed. Bevacizumab (Avastin, 1.25 mg/0.05 ml) was injected intravitreously for the treatment of iris and retinal neovascularization in a 56-year old Hispanic female with photocoagulation treatment to control the recurrence of vitreous haemorrhage. Our results revealed that stabilization of the disease and improvement in visual acuity were achieved without any signs of recurrence. Intravitreal bevacizumab in combination with photocoagulation treatment of ischemic retinal areas may be a good alternative for patients with recurrent vitreous haemorrhage due to Eales disease.
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Kumar A, Sehra SV, Thirumalesh MB, Gogia V. Secondary rhegmatogenous retinal detachment following intravitreal bevacizumab in patients with vitreous hemorrhage or tractional retinal detachment secondary to Eales' disease. Graefes Arch Clin Exp Ophthalmol 2011; 250:685-90. [PMID: 22169980 DOI: 10.1007/s00417-011-1890-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Revised: 11/12/2011] [Accepted: 11/29/2011] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND To report the occurrence of secondary rhegmatogenous retinal detachment (RRD) after intravitreal bevacizumab injection in patients with Eales' disease. METHODS This is a retrospective, non-controlled, comparative case series. We reviewed 14 eyes of 14 patients with Eales' disease who had received pretreatment with intravitreal bevacizumab (1.25 mg/0.05 ml) and subsequently undergone a pars plana vitrectomy for non-resolving vitreous hemorrhage and/or tractional retinal detachment. Clinical records were reviewed. The primary outcome measure was the occurrence of secondary RRD after intravitreal bevacizumab injection. RESULTS Four patients had developed secondary RRD, with retinal breaks that were localized to the base of tractional retinal bands, within 1 week of receiving intravitreal bevacizumab. On comparative analysis, median age of patients who had developed secondary RRD was 26.5 years, significantly less than the median age of 33.5 years in the rest (P = 0.022). Median post-operative best-corrected visual acuity (BCVA) in patients who developed secondary RRD was logMAR 0.7 (0.3-0.8), significantly worse than the BCVA of logMAR 0.3 (0.0-0.5) in the rest (P = 0.015). None of the patients who developed secondary RRD had a complete posterior vitreous detachment (PVD) at presentation. CONCLUSION Intravitreal bevacizumab injections may be associated with the serious complication of secondary RRD in patients of Eales' disease within 7 days of injection.
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Affiliation(s)
- Atul Kumar
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
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Role of intravitreal bevacizumab in Eales disease with dense vitreous hemorrhage: a prospective randomized control study. Retina 2011; 31:866-70. [PMID: 21301382 DOI: 10.1097/iae.0b013e3181f2a27f] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE To investigate the role of intravitreal bevacizumab in Eales disease with dense vitreous hemorrhage. METHODS This is a prospective randomized control trial. Twenty eyes of 20 patients with dense vitreous hemorrhage because of Eales disease were randomly distributed in Group 1 (n = 10) and Group 2 (n = 10). Group 1 eyes received intravitreal injection of bevacizumab (1.25 mg/0.05 mL) every 4 weeks, and Group 2 eyes were observed. Patients of both groups were followed-up every 2 weeks. Vitrectomy was performed in case of nonresolving vitreous hemorrhage Grade 2 or more after 3 months of enrollment or immediately if retinal detachment was detected. Intraoperative difficulties while performing surgery and excessive bleeding were noted. The primary outcome measures were reduction in the grade of vitreous hemorrhage and the need for vitrectomy. RESULTS Only 1 eye from Group 1 and 2 eyes from Group 2 showed decrease in vitreous hemorrhage to Grade 2 (P = 0.531, 95% confidence interval). But all three eyes required vitrectomy because of persisting poor vision. Postoperative mean vision ± SD in Group 1 was 1.2 ± 0.57 in logarithm of the minimum angle of resolution units, and in Group 2, it was 0.78 ± 0.41 in logarithm of the minimum angle of resolution units (P = 0.086, 95% confidence interval). Three eyes (30%) in Group 1 had tractional retinal detachment after a single bevacizumab injection, while none of the Group 2 eyes had tractional retinal detachment (P = 0.060, 95% confidence interval). Vitrectomy was performed in all three eyes and had poor visual outcome after surgery. No intraoperative difficulties were noted in either group. CONCLUSION Our study showed that repeated intravitreal bevacizumab in patients with Eales disease with dense vitreous hemorrhage may not hasten the resolution of vitreous hemorrhage or reduce the need for vitrectomy. Moreover, tractional retinal detachment may be a serious complication of therapy and hence should be closely monitored because it entails a poor visual prognosis.
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Diallo JW, Nikiema Z, Daboue A, Tieno H, Meda N, Kan GR. [Eales disease: a case report in Burkina Faso]. J Fr Ophtalmol 2011; 34:539-42. [PMID: 21803446 DOI: 10.1016/j.jfo.2011.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Accepted: 01/10/2011] [Indexed: 10/17/2022]
Abstract
The authors report the first case of Eales disease described in Burkina Faso. A 21-year-old man presented myodesopsia with acute visual acuity decrease in the right eye at 1/50, vitreous haemorrhage, and retinal phlebitis of the large trunks. In the left eye, visual acuity was 10/10 P2, with phlebitis associated with retinal haemorrhages, vascular occlusion, and retinal ischaemia. Laboratory investigations found a positive TST at 20mm but the Koch bacillus was not isolated. The patient received treatment for tuberculosis, corticosteroids, retinal argon laser photocoagulation, and vitrectomy in the right eye. The clinical, immunopathological, and therapeutic aspects of Eales disease are discussed.
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Affiliation(s)
- J W Diallo
- Centre hospitalier universitaire Sourô Sanou, 01, BP 676, Bobo Dioulasso, Burkina Faso.
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Abu El-Asrar AM, Herbort CP, Tabbara KF. Differential diagnosis of retinal vasculitis. Middle East Afr J Ophthalmol 2011; 16:202-18. [PMID: 20404987 PMCID: PMC2855661 DOI: 10.4103/0974-9233.58423] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Retinal vaculitis is a sight-threatening inflammatory eye condition that involves the retinal vessels. Detection of retinal vasculitis is made clinically, and confirmed with the help of fundus fluorescein angiography. Active vascular disease is characterized by exudates around retinal vessels resulting in white sheathing or cuffing of the affected vessels. In this review, a practical approach to the diagnosis of retinal vasculitis is discussed based on ophthalmoscopic and fundus fluorescein angiographic findings.
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Affiliation(s)
- Ahmed M Abu El-Asrar
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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25
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M A, El-Asrar A, Abouammoh M, Al-Mezaine HS. Tuberculous uveitis. Middle East Afr J Ophthalmol 2011; 16:188-201. [PMID: 20404986 PMCID: PMC2855660 DOI: 10.4103/0974-9233.58421] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In recent years, ocular involvement due to TB has re-emerged. Tuberculous uveitis is a readily treatable disease and the consequences of delay in either ocular or systemic diagnosis can be very serious for the patient. It is important to have a high index of suspicion of the diagnosis in patients with unexplained chronic uveitis and this will be influenced by the socio-economic circumstances, family history, ethnic origin, and previous medical history of the patient. Treatment with antituberculous therapy combined with systemic corticosteroids resolves inflammation without recurrences after medical therapy.
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Affiliation(s)
- Ahmed M
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Anti-tuberculous therapy combined with systemic corticosteroids improves retinal sensitivity in patients with active presumed tuberculous choroiditis. Int Ophthalmol 2010; 30:567-76. [DOI: 10.1007/s10792-010-9371-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2010] [Accepted: 05/02/2010] [Indexed: 10/19/2022]
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Abstract
Retinal vasculitis is a sight-threatening intraocular inflammation affecting the retinal vessels. It may occur as an isolated ocular condition, as a manifestation of infectious or neoplastic disorders, or in association with a systemic inflammatory disease. The search for an underlying etiology should be approached in a multidisciplinary fashion based on a thorough history, review of systems, physical examination, and laboratory evaluation. Discrimination between infectious and noninfectious etiologies of retinal vasculitis is important because their treatment is different. This review is based on recently published articles on retinal vasculitis and deals with its clinical diagnosis, its link with systemic diseases, and its laboratory investigation.
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Affiliation(s)
- Ahmed M Abu El-Asrar
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
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Davis J, Schecter SH, Sowka J. Eales' disease: the great masquerader. OPTOMETRY (ST. LOUIS, MO.) 2009; 80:354-359. [PMID: 19545848 DOI: 10.1016/j.optm.2008.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Revised: 07/05/2008] [Accepted: 10/17/2008] [Indexed: 05/28/2023]
Abstract
BACKGROUND Eales' disease, also known as idiopathic retinal periphlebitis, is a diagnosis of exclusion, mainly affecting men in the second through fourth decades of life. Although less common in the United States, Eales' disease is widespread in India and certain areas of the Middle East. CASE REPORT A healthy, 42-year-old Filipino man presented with reduced vision in the right eye of 2 days' duration and had recently had a nonrhegmatogenous retinal detachment diagnosed. Clinical findings included angle neovascularization, posterior vitritis, intraretinal hemorrhages, and retinal vascular sheathing in that eye. Systemic evaluation did not disclose an underlying etiology. Eales' disease was diagnosed. Treatment included topical steroids and cycloplegia, along with intravitreal triamcinolone acetonide injection, which yielded an improvement in the vasculitis and vitritis with subsequent visual improvement and stabilization. CONCLUSION Eales' disease should be considered as a differential diagnosis in patients with vasculitis and vitritis.
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Affiliation(s)
- Jeanmarie Davis
- Nova Southeastern University College of Optometry, Ft. Lauderdale, Florida 33027, USA.
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Abu El-Asrar AM, Herbort CP, Tabbara KF. A clinical approach to the diagnosis of retinal vasculitis. Int Ophthalmol 2009; 30:149-73. [DOI: 10.1007/s10792-009-9301-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2008] [Accepted: 01/14/2009] [Indexed: 11/29/2022]
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Moon SW, Song Y, Cho HY, Lee BR, Sohn JH, Park YS. The Effect of Intravitreal Bevacizumab Injection in Eales' Disease. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2009. [DOI: 10.3341/jkos.2009.50.10.1595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sang Won Moon
- Department of Ophthalmology, College of Medicine, Hanyang University Hospital, Seoul, Korea
| | - Yumi Song
- Department of Ophthalmology, College of Medicine, Hanyang University Hospital, Seoul, Korea
| | - Hee Yoon Cho
- Department of Ophthalmology, College of Medicine, Hanyang University Hospital, Seoul, Korea
| | - Byung Ro Lee
- Department of Ophthalmology, College of Medicine, Hanyang University Hospital, Seoul, Korea
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Al-Mezaine HS, Al-Muammar A, Kangave D, Abu El-Asrar AM. Clinical and optical coherence tomographic findings and outcome of treatment in patients with presumed tuberculous uveitis. Int Ophthalmol 2007; 28:413-23. [PMID: 18034214 DOI: 10.1007/s10792-007-9170-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2007] [Accepted: 10/23/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE To define the clinical characteristics and optical coherence tomographic (OCT) features, and to assess the outcome of treatment, in patients with presumed tuberculous uveitis (PTU). METHODS All patients diagnosed with PTU at King Abdulaziz University Hospital between January 1998 and May 2006 were reviewed. The diagnosis was made when findings were consistent with possible intraocular tuberculosis with no other cause of uveitis suggested by history, symptoms, or ancillary testing, strongly positive tuberculin skin-test results, and response to antituberculous therapy. RESULTS Fifty-one patients (73 eyes) were identified. There were 34 males (66.7%) and 17 females (33.3%) with a mean age of 40.1+/-11.0 years (range 16-68 years). Fifty-eight eyes (79.5%) had panuveitis and 15 eyes (20.5%) had posterior uveitis at presentation. Clinical manifestations included vitritis (71.2%), macular edema (63%), retinal periphlebitis (35.6%), multifocal choroiditis (20.5%), and granulomatous anterior uveitis (17.9%). All patients received antituberculous therapy and systemic corticosteroids. After a mean follow-up of 18.9+/-21.9 months (range 6-96 months), all eyes showed resolution of inflammation, with no recurrences, associated with significant improvement in visual acuity (VA) (P=0.007). There was a significant positive correlation between initial and final VAs (r=0.7856, P<0.001). Thirty-one eyes with macular edema were examined at baseline and at follow-up with OCT. There were three patterns of macular edema: diffuse (DME) (28.5%), cystoid (29%), and serous retinal detachment (45.2%). Initial VA of 20/40 or better was significantly associated with central macular thickness (CMT) of 300 microm or less (P=0.0065) and DME (0.0484). At final follow-up, there was a significant reduction in CMT (P<0.001) associated with a significant improvement in VA (P=0.0091). CONCLUSIONS Antituberculous therapy combined with systemic corticosteroids leads to resolution of inflammation and elimination of recurrences of PTU. OCT is useful in monitoring the efficacy of treatment in patients with macular edema.
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Affiliation(s)
- Hani S Al-Mezaine
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Abstract
AIM To present and analyse the anatomical and functional outcomes for vitrectomy in Eales' disease. METHODS This retrospective case series enrolled 63 patients (71 eyes) who underwent pars plana vitrectomy (PPV) for the complications of Eales' disease. Indications included nonclearing vitreous haemorrhage (VH) with/without epiretinal membranes in 49 (69%) eyes, and retinal detachments (RD) involving/threatening macula in 22 (31%). Additional procedures (scleral buckling; gas/oil tamponade) were performed at surgeon's discretion. Minimum follow-up was 6 months. The primary outcome measures were change in best-corrected visual acuity (BCVA) and posterior segment status. RESULTS The mean age of the patients was 29.6 years (range: 15-70 years); 60 were male (95%). Preoperatively, posterior vitreous detachment (PVD) existed in 28 (39.4%) eyes. Forty (56.3%) eyes underwent only PPV; the rest required additional surgical procedures (q.v.). The mean baseline BCVA (1/60) improved to 6/24 postoperatively (P<0.0001). Fifty-four eyes of 50 patients (76%) showed an improvement of > or =2 equivalent Snellen lines; six eyes (four patients) remained stable (+/-1 line); visual acuity worsened in 11 eyes (nine patients). The mean final BCVA was similar in eyes operated for VH and RD (P=0.08); but the magnitude of change from baseline was greater in the VH group (P=0.009). PVD had a borderline association with final BCVA (P=0.056); but did not influence the functional/anatomical improvement. Thirteen eyes required repeat interventions; 11 (15.49%) eyes experienced surgical failure. CONCLUSIONS Although surgical outcomes in Eales' disease depend on preoperative PVD/RD to some extent; good results are possible in the presence of incomplete PVD and tractional sequelae.
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Affiliation(s)
- D Shukla
- Retina-Vitreous Service, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India.
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34
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Barazi MK, Murphy RP. Eales Disease. Retina 2006. [DOI: 10.1016/b978-0-323-02598-0.50088-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Mistr S, Chavis PS. Treatment of neuro-ophthalmologic manifestations of tuberculosis. Curr Treat Options Neurol 2005; 8:53-67. [PMID: 16343361 DOI: 10.1007/s11940-996-0024-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In the absence of obvious pulmonary or disseminated tuberculosis, ocular and central nervous system (CNS) tuberculosis may represent a significant diagnostic challenge. Refinements in polymerase chain reaction techniques and neuroimaging have strengthened the battery of tests used to diagnose CNS and ocular tuberculosis, yet in many cases, the diagnosis remains one of exclusion; it may ultimately be determined through exacerbation by anti-inflammatory therapy with subsequent improvement by antitubercular medication treatment. Because of emerging drug resistance, at least a two-drug regimen is required for therapeutic testing and treatment of isolated ocular tuberculosis. If pulmonary or miliary disease coexists, a 6-month, four-drug regimen with isoniazid, rifampin, pyrazinamide, and ethambutol is required for treatment. Tubercular meningitis is treated with the same four-drug regimen for at least 9 to 12 months. Burden of therapeutic compliance rests on the treating physician and public health sector. Best compliance is realized with directly observed therapy.
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Affiliation(s)
- Susannah Mistr
- Storm Eye Institute, Department of Ophthalmology, Medical University of South Carolina, 167 Ashley Avenue, Charleston, SC 29425, USA
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Majji AB, Vemuganti GK, Shah VA, Singh S, Das T, Jalali S. A comparative study of epiretinal membranes associated with Eales' disease: a clinicopathologic evaluation. Eye (Lond) 2005; 20:46-54. [PMID: 15877102 DOI: 10.1038/sj.eye.6701788] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
AIM To study the histopathologic features and clinical correlation of epiretinal membranes (ERM) obtained from patients of Eales' disease and compare with other vasoproliferative disorders. METHODS Retrospective analysis of epiretinal membranes submitted for histological evaluation between January 1995 and June 2001, from the patients of diabetic retinopathy and vascular occlusions (Group 1; vaso-occlusive disorders) and of Eales' disease (Group 2; vasoinflammatory disorders). Demographics, pre and postoperative visual acuity, and anatomic and histologic characteristics of membranes were studied. Histopathologic features and clinical outcomes were correlated between the groups. The results were analysed statistically by Student's t-test, Fisher's exact test and Kruskal-Wallis test. RESULTS This study consisted of 42 patients, 24 in Group 1 and 18 in Group 2. Patients in Group 2 (33.0+/-9.2 years) were significantly younger than the patients in Group 1 (49.9+/-7.6 years) (P< or =0.0001). Final visual acuity of >20/400 was attained in 79.2% (19/24) patients in Group 1 and 83.3% (15/18) in Group 2 (P=1.0). Inflammatory membranes were significantly associated with presumed Eales' disease (94.4 vs 0%) (P< or =0.0001) and fibrovascular membranes with Group 1 (70.8% vs 33.3%) (P=0.028). Mast cells and eosinophils were observed as special features in epiretinal membranes of patients with Eales' disease. CONCLUSIONS Histological features of ERM in Eales' disease are comparable to other vasoproliferative disorders except for features of inflammation. Presence of mast cells and eosinophils in epiretinal membranes of Eales' disease needs further investigation.
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Affiliation(s)
- A B Majji
- Smt Kanuri Santhamma Retina-Vitreous Centre, LV Prasad Eye Institute, Hyderabad, India.
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Abstract
PURPOSE OF REVIEW The ophthalmologist has direct visual access to inflamed vessels when examining the retina, and "vasculitis" in ophthalmology has so far mainly referred to retinal vasculitis. In the past few years the means to explore vasculitis in the ocular sphere have improved. Indocyanine green angiography now enables the analysis of choroidal inflammatory vasculopathy as well as vasculitis of the sclera (scleritis) and episclera (episcleritis) in addition to retinal vasculitis. Because vasculitis detected by the ophthalmologist can be the presenting sign of a systemic disease and has to be approached in a multidisciplinary fashion, the emerging term "ocular vasculitis," instead of retinal vasculitis, should be used in the future. The term covers vasculitis affecting all structures of the eye and the periocular tissues as detailed in this article. The ocular findings have to be integrated within the established and accepted classification of systemic vasculitis, which is divided into primary vasculitides, where the vessel itself is the target of the inflammatory reaction, and secondary vasculitides, caused by other inflammatory processes. This review will deal with recently published articles on ocular vasculitis, including its clinical aspects, its link with systemic diseases, and its investigation and management. The discussion will be conducted within the framework of the new classification put forward here. RECENT FINDINGS Novel imaging techniques such as indocyanine green angiography have made it possible to explore inflammation of choroidal vessels and of scleral vasculitis in addition to retinal vasculitis, contributing to the global concept of ocular vasculitis. It has been shown, in particular, that the choriocapillaris, a vascular structure adjacent to the retina, can be the site of a primary inflammatory vasculopathy unrecognized so far. Most of the recent articles cited, however, deal not so much with new findings but with the integration of ocular pathologic changes into the systemic diseases they are part of. New knowledge about disease mechanisms and novel therapeutic modalities with biologic agents cited in this review are coming from other fields but have contributed to progress in the management of ocular vasculitis. SUMMARY New investigational techniques of vasculitis in ocular structures other than the retina have contributed to the development of the global concept of ocular vasculitis. This review shows the importance of promoting a comprehensive and global classification of ocular vasculitis compatible with the concepts accepted for systemic vasculitis to contribute to its multidisciplinary approach.
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Affiliation(s)
- Carl P Herbort
- Inflammatory Eye Diseases, La Source Eye Centre, and University of Lausanne, Lausanne, Switzerland.
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Abstract
Retinal vasculitis represents a group of diseases characterized by inflammation affecting the retinal vasculature. It is an uncommon disorder that may occur as an isolated disease or more commonly in association with other ocular diseases or a variety of systemic diseases. With a wide variety of disease associations, a search for an underlying etiology should be undertaken based on a meticulous history, review of systems, and physical examination. The laboratory evaluation of patients with retinal vasculitis is an essential component of the work-up to facilitate detection of any underlying disease or to establish a limited differential diagnosis. The management of infectious causes of retinal vasculitis consists of antimicrobial therapy while noninfectious retinal vasculitis is managed with corticosteroids and/or immunosuppressive agents. Because retinal vasculitis is an uncommon disease, there are only a limited number of publications over the past year related to this topic.
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Affiliation(s)
- R Christopher Walton
- Department of Ophthalmology, University of Tennessee College of Medicine, Memphis, 38163, USA.
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