Eales Disease Treatment & Management
- Author: Daniel B Roth, MD; Chief Editor: Hampton Roy, Sr, MD more...
Several treatments have been proposed for Eales disease; however, none of these treatments is of proven benefit. Treatments include thyroid extract, osteogenic hormones, androgenic hormones, and systemic steroids. The antioxidant vitamins A, C, and E have been suggested as a possible therapy because antioxidizing enzymes are deficient in the vitreous samples of patients with Eales disease.
In cases complicated by cystoid macular edema, intravitreal triamcinolone acetonide has been effectively used in reversing the edema and in leading to visual improvement. Doses of 1-25 mg of triamcinolone have been reported; however, doses of 2-4 mg of triamcinolone are more commonly used in clinical practice.
Intravitreal injections of bevacizumab have been reported to induce regression of the neovascularization associated with Eales disease. Bevacizumab also reduces cystoid macular edema in Eales disease by inhibiting vascular endothelial growth factor (VEGF)–mediated capillary hyperpermeability.[14, 15, 16, 17]
A randomized, prospective trial with intravitrealbevacizumab was performed in eyes with vitreous hemorrhage secondary to Eales disease. The small study demonstrated bevacizumab did not hasten resolution of vitreous hemorrhage and had a trend toward increased risk of progression to tractional retinal detachment.
A completed clinical trial is Lucentis (Ranibizumab) for Eales' Disease.
Moderately light, full-scatter laser photocoagulation to areas of nonperfused retina has become the treatment of choice in patients with Eales disease.[19, 20] The junctional area between perfused and nonperfused retina is to be treated. This treatment results in resolution of neovascularization of the disc, elsewhere in the retina, or the iris, and lowers the incidence of vitreous hemorrhage.
A major cause of visual loss in patients with Eales disease results from recurrent vitreous hemorrhage. Although the hemorrhage often settles in the inferior portion of the vitreous and reabsorbs within several weeks, surgical intervention occasionally is indicated. Pars plana vitrectomy is effective in removing nonclearing vitreous hemorrhage and enabling adequate scatter laser photocoagulation. In cases of tractional retinal detachment, vitrectomy in combination with membrane dissection is necessary.
Consultation with a neurologist is appropriate in the setting of concomitant neurologic symptoms.
No dietary modification has been proven to be of benefit in Eales disease. However, studies suggest that vitamin A, C, and E supplementation may have a beneficial effect.
No limitations in activity exist for patients with Eales disease. However, in the setting of vitreous hemorrhage, a sitting position may expedite the clearing of the central visual axis, as the blood is reabsorbed.
Singh R, Toor P, Parchand S, Sharma K, Gupta V, Gupta A. Quantitative polymerase chain reaction for Mycobacterium tuberculosis in so-called Eales' disease. Ocul Immunol Inflamm. 2012 Jun. 20(3):153-7. [Medline].
Gieser AS, Murphy RP. Eales disease. Retina. 1994. Vol 2: 1503-07.
Phanthumchinda K. Eales' disease with myelopathy. J Med Assoc Thai. 1992 Apr. 75(4):255-8. [Medline].
Sawhney IM, Chopra JS, Bansal SK, Gupta AK. Eales' disease with myelopathy. Clin Neurol Neurosurg. 1986. 88(3):213-5. [Medline].
Gordon MF, Coyle PK, Golub B. Eales' disease presenting as stroke in the young adult. Ann Neurol. 1988 Aug. 24(2):264-6. [Medline].
Kutsal YG, Altioklar K, Atasü S, Kutluk K, Atmaca L. Eales' disease with hemiplegia. Clin Neurol Neurosurg. 1987. 89(4):283-6. [Medline].
Antiguedad A, Zarranz JJ. [Eales' disease involving central nervous system white matter]. Neurologia. 1994 Aug-Sep. 9(7):307-10. [Medline].
Katz B, Wheeler D, Weinreb RN, Swenson MR. Eales' disease with central nervous system infarction. Ann Ophthalmol. 1991 Dec. 23(12):460-3. [Medline].
Saxena S, Pant AB, Khanna VK, Agarwal AK, Singh K, Kumar D. Interleukin-1 and tumor necrosis factor-alpha: novel targets for immunotherapy in Eales disease. Ocul Immunol Inflamm. 2009 May-Jun. 17(3):201-6. [Medline].
Sen A, Paine SK, Chowdhury IH, Mondal LK, Mukherjee A, Biswas A. Association of interferon-gamma, interleukin-10, and tumor necrosis factor-alpha gene polymorphisms with occurrence and severity of Eales' disease. Invest Ophthalmol Vis Sci. 2011 Jan. 52(1):171-8. [Medline].
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. 1997 Feb. 16(2):91-5. [Medline].
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. 1999 Sep. 19(3):254-9. [Medline].
Agrawal S, Agrawal J, Agrawal TP. Intravitreal triamcinolone acetonide in Eales disease. Retina. 2006 Feb. 26(2):227-9. [Medline].
Chanana B, Azad RV, Patwardhan S. Role of intravitreal bevacizumab in the management of Eales' disease. Int Ophthalmol. 2010 Feb. 30(1):57-61. [Medline].
Moyenin P, Grange JD. [Eales' syndrome. Clinical aspects, therapeutic indications and course of 29 cases]. J Fr Ophtalmol. 1987. 10(2):123-8. [Medline].
Kucukerdonmez C, Akova YA, Yilmaz G. Intravitreal injection of bevacizumab in Eales disease. Ocul Immunol Inflamm. 2008 Jan-Feb. 16(1):63-5. [Medline].
Kumar A, Sinha S. Rapid regression of disc and retinal neovascularization in a case of Eales disease after intravitreal bevacizumab. Can J Ophthalmol. 2007 Apr. 42(2):335-6. [Medline].
Patwardhan SD, Azad R, Shah BM, Sharma Y. Role of intravitreal bevacizumab in Eales disease with dense vitreous hemorrhage: a prospective randomized control study. Retina. 2011 May. 31(5):866-70. [Medline].
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].
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].
Eller AW, Bontempo FA, Faruki H, Hassett AC. Peripheral retinal neovascularization (Eales disease) associated with the factor V Leiden mutation. Am J Ophthalmol. 1998 Jul. 126(1):146-9. [Medline].
Elliot AJ. 30-year observation of patients with Eale's disease. Am J Ophthalmol. 1975 Sep. 80(3 Pt 1):404-8. [Medline].
Gieser SC, Murphy RP. Eales disease. Principles and Practice of Ophthalmology. 1994. 2: 791-795.
Magargal LE, Walsh AW, Magargal HO, Robb-Doyle E. Treatment of Eales' disease with scatter laser photocoagulation. Ann Ophthalmol. 1989 Aug. 21(8):300-2. [Medline].
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].
Renie WA, Murphy RP, Anderson KC, et al. The evaluation of patients with Eales' disease. Retina. 1983 Fall-Winter. 3(4):243-8. [Medline].
Singhal BS, Dastur DK. Eales' disease with neurological involvement Part 1. Clinical features in 9 patients. J Neurol Sci. 1976 Mar. 27(3):313-21. [Medline].
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].
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].