Eales Disease Treatment & Management

Updated: Sep 28, 2018
  • Author: Jonathan C Tsui, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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Treatment

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. [19] 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. [20]

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. [21, 22, 23, 24]

A randomized, prospective trial with intravitreal bevacizumab 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. [25]

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. [26, 27] 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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Long-Term Monitoring

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

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