eMedicine Specialties > Ophthalmology > Retina

Eales Disease: Follow-up

Author: Daniel B Roth, MD, Assistant Clinical Professor, Department of Ophthalmology, University of Medicine and Dentistry of New Jersey
Contributor Information and Disclosures

Updated: Dec 14, 2007

Follow-up

Further Outpatient Care

  • After scatter laser photocoagulation, monitor the patient for regression or progression of neovascularization. Instruct the patient to contact an ophthalmologist if a decrease or change in vision is noted.

Complications

  • Complications of retinal neovascularization can lead to severe visual loss due to persistent vitreous hemorrhage and retinal detachment.
  • Anterior segment neovascularization can cause neovascular glaucoma with resultant visual loss and, occasionally, even loss of the eye.
  • Peripheral retinal nonperfusion can limit a patient's visual field, and, if the area of nonperfusion extends into the macula, severe visual loss may result. No effective treatment exists to prevent capillary nonperfusion.
  • Macular puckering has been reported to occur in 3% of eyes after scatter laser photocoagulation treatment of Eales disease.

Prognosis

  • More than 90% of patients can be brought to a morphological standstill with unchanging visual acuity.
  • Gieser and Murphy reported that 67% of patients had a final visual acuity in the better eye of 20/40 or better, 24% ranged from 20/50 to 20/200, and 9% were worse than 20/250.1
  • In another study from India, 72% of eyes that underwent vitrectomy for complications of Eales disease maintained a vision of 20/200 or better over 5 years of follow-up care.2

Patient Education

  • Patients should be educated to report visual symptoms of floaters or decreased vision to their ophthalmologist as soon as possible, in order to implement effective treatment and to prevent the need of vitrectomy surgery for vitreous hemorrhage or retinal detachment.

Miscellaneous

Medicolegal Pitfalls

  • Eales disease is a diagnosis of exclusion and other possible entities causing peripheral retinal neovascularization and vasculitis must be eliminated from the differential diagnosis. An appropriate workup to rule out these conditions is necessary, because many of them are treatable. Such diagnoses include the following:
    • Sickle cell disease
    • Beta thalassemia
    • Small vessel hyalinosis
    • Diabetes mellitus
    • Branch retinal vein or arterial occlusion
    • Retinal embolization
    • Retinopathy of prematurity
    • Familial exudative vitreoretinopathy
    • Hyperviscosity syndromes (eg, leukemia)
    • Ocular ischemic syndrome
    • Carotid-cavernous fistula
    • Multiple sclerosis
    • Toxemia of pregnancy
    • Sarcoidosis
    • Collagen vascular disease
    • Vasculitis secondary to infection
    • Uveitis
    • Birdshot retinochoroidopathy
    • Toxoplasmosis
    • Acute retinal necrosis
    • Long-standing retinal detachment
    • Retinitis pigmentosa
    • Retinoschisis
    • Choroidal melanoma or hemangioma
    • Incontinentia pigmenti
 


More on Eales Disease

Overview: Eales Disease
Differential Diagnoses & Workup: Eales Disease
Treatment & Medication: Eales Disease
Follow-up: Eales Disease
Multimedia: Eales Disease
References
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References

  1. Gieser AS, Murphy RP. Eales disease. In: Retina. Vol 2. 1994:1503-07.

  2. Shanmugam MP, Badrinath SS, Gopal L, Sharma T. Long term visual results of vitrectomy for Eales disease complications. Int Ophthalmol. 1998;22(1):61-4. [Medline].

  3. Antigüedad A, Zarranz JJ. [Eales' disease involving central nervous system white matter]. Neurologia. Aug-Sep 1994;9(7):307-10. [Medline].

  4. Bhooma V, Sulochana KN, Biswas J, Ramakrishnan S. Eales' disease: accumulation of reactive oxygen intermediates and lipid peroxides and decrease of antioxidants causing inflammation, neovascularization and retinal damage. Curr Eye Res. Feb 1997;16(2):91-5. [Medline].

  5. Das T, Namperumalsamy P. Combined photocoagulation and cryotherapy in treatment of Eales' retinopathy. Preliminary report. Indian J Ophthalmol. 1987;35(5-6):108-18. [Medline].

  6. Eller AW, Bontempo FA, Faruki H, Hassett AC. Peripheral retinal neovascularization (Eales disease) associated with the factor V Leiden mutation. Am J Ophthalmol. Jul 1998;126(1):146-9. [Medline].

  7. Elliot AJ. 30-year observation of patients with Eale's disease. Am J Ophthalmol. Sep 1975;80(3 Pt 1):404-8. [Medline].

  8. Gieser SC, Murphy RP. Eales disease. In: Principles and Practice of Ophthalmology. Vol 2. 1994:791-795.

  9. Gordon MF, Coyle PK, Golub B. Eales' disease presenting as stroke in the young adult. Ann Neurol. Aug 1988;24(2):264-6. [Medline].

  10. Katz B, Wheeler D, Weinreb RN, Swenson MR. Eales' disease with central nervous system infarction. Ann Ophthalmol. Dec 1991;23(12):460-3. [Medline].

  11. Kutsal YG, Altioklar K, Atasu S, Kutluk K, Atmaca L. Eales' disease with hemiplegia. Clin Neurol Neurosurg. 1987;89(4):283-6. [Medline].

  12. Magargal LE, Walsh AW, Magargal HO, Robb-Doyle E. Treatment of Eales' disease with scatter laser photocoagulation. Ann Ophthalmol. Aug 1989;21(8):300-2. [Medline].

  13. Masson C, Denis P, Prier S, Martin N, Masson M, Cambier J. [Eales' disease with neurologic disorders]. Rev Neurol (Paris). 1988;144(12):817-9. [Medline].

  14. Pathengay A, Pilli S, Das T. Intravitreal triamcinolone acetonide in Eales' disease: a case report. Eye. Jun 2005;19(6):711-3. [Medline].

  15. Phanthumchinda K. Eales' disease with myelopathy. J Med Assoc Thai. Apr 1992;75(4):255-8. [Medline].

  16. Renie WA, Murphy RP, Anderson KC, Lippman SM, McKusick VA, Proctor LR, et al. The evaluation of patients with Eales' disease. Retina. Fall-Winter 1983;3(4):243-8. [Medline].

  17. Sawhney IM, Chopra JS, Bansal SK, Gupta AK. Eales' disease with myelopathy. Clin Neurol Neurosurg. 1986;88(3):213-5. [Medline].

  18. Singhal BS, Dastur DK. Eales' disease with neurological involvement Part 1. Clinical features in 9 patients. J Neurol Sci. Mar 1976;27(3):313-21. [Medline].

  19. Spitznas M, Meyer-Schwicherath G, Stephan B. Treatment of Eales' disease with photocoagulation. Albrecht Von Graefes Arch Klin Exp Ophthalmol. 1975;194(3):193-8. [Medline].

  20. Spitznas M, Meyer-Schwickerath G, Stephan B. The clinical picture of Eales' disease. Albrecht Von Graefes Arch Klin Exp Ophthalmol. 1975;194(2):73-85. [Medline].

  21. Sulochana KN, Biswas J, Ramakrishnan S. Eales' disease: increased oxidation and peroxidation products of membrane constituents chiefly lipids and decreased antioxidant enzymes and reduced glutathione in vitreous. Curr Eye Res. Sep 1999;19(3):254-9. [Medline].

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Further Reading

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Keywords

Eales' disease, Eale's disease, idiopathic obliterative vasculopathy, idiopathic recurrent vitreal hemorrhage, periphlebitis retinae

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Contributor Information and Disclosures

Author

Daniel B Roth, MD, Assistant Clinical Professor, Department of Ophthalmology, University of Medicine and Dentistry of New Jersey
Daniel B Roth, MD is a member of the following medical societies: American Academy of Ophthalmology and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Russell P Jayne, MD, Consulting Vitreoretinal Surgeon, The Retina Center at Las Vegas
Russell P Jayne, MD is a member of the following medical societies: American Medical Association, American Society of Cataract and Refractive Surgery, and American Society of Retina Specialists
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Steve Charles, MD, Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine
Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Club Jules Gonin, Macula Society, and Retina Society
Disclosure: Alcon Laboratories Consulting fee Consulting

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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