Eales Disease Treatment & Management

  • Author: Daniel B Roth, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Feb 25, 2010
 

Medical Care

  • 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.[10] 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.[11]
  • 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.[12, 13, 14, 15]
  • A completed clinical trial is Lucentis (Ranibizumab) for Eales' Disease.
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Surgical Care

  • Moderately light, full-scatter laser photocoagulation to areas of nonperfused retina has become the treatment of choice in patients with Eales disease.[16, 17] 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.
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Consultations

Consultation with a neurologist is appropriate in the setting of concomitant neurologic symptoms.

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Diet

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.

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Activity

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.

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Contributor Information and Disclosures
Author

Daniel B Roth, MD  Assistant Professor, Department of Ophthalmology, University of Medicine and Dentistry of New Jersey Robert Wood Johnson Medical School, Retina Vitreous Center

Daniel B Roth, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Retina Specialists, Association for Research in Vision and Ophthalmology, and Retina Society

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

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.

Steve Charles, MD  Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine; Adjunct Professor of Ophthalmology, Columbia College of Physicians & Surgeons; Clinical Professor Ophthalmology, Chinese University of Hong Kong

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; OptiMedica Ownership interest Consulting

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.

References

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

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

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

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

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

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

  8. 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].

  9. 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].

  10. .

  11. Agrawal S, Agrawal J, Agrawal TP. Intravitreal triamcinolone acetonide in Eales disease. Retina. Feb 2006;26(2):227-9. [Medline].

  12. Chanana B, Azad RV, Patwardhan S. Role of intravitreal bevacizumab in the management of Eales' disease. Int Ophthalmol. Feb 2010;30(1):57-61. [Medline].

  13. Moyenin P, Grange JD. [Eales' syndrome. Clinical aspects, therapeutic indications and course of 29 cases]. J Fr Ophtalmol. 1987;10(2):123-8. [Medline].

  14. Küçükerdönmez C, Akova YA, Yilmaz G. Intravitreal injection of bevacizumab in Eales disease. Ocul Immunol Inflamm. Jan-Feb 2008;16(1):63-5. [Medline].

  15. Kumar A, Sinha S. Rapid regression of disc and retinal neovascularization in a case of Eales disease after intravitreal bevacizumab. Can J Ophthalmol. Apr 2007;42(2):335-6. [Medline].

  16. 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].

  17. 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].

  18. 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].

  19. 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].

  20. 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].

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

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

  23. 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].

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

  25. 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].

  26. 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].

 
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Eales disease. Fundus photo of the peripheral retina, revealing vascular tortuosity and peripheral retinal neovascularization.
Eales disease. Fluorescein angiogram of late leakage from peripheral retinal neovascularization.
 
 
 
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