1. Eales' disease Dr Chinmayi Vyas M.S. Dr Jyotirmay Biswas
M.S., FAMS, FIC Path,FAICO
Director of Uveitis and Ophthalmic pathology
Sankara Nethralaya, Chennai,India

2. Ocular History 30 year old lady
February 2012 complaints of left eye blurred vision with floaters.
No h/o similar problems
Systemic history : unremarkable

3. February 2012 : First Presentation
Right eye
Left eye
BCVA
6/6; N6
3/60, N36
IOP 35 28
Anterior segment
Normal
Vitreous cells ++
Fundus findings
Occlusive vasculitis with active retinitis in superiotemporal quadrant

6. February 2012 : First Presentation
ESR:12 mm
Mantoux Test : positive
Serum Angiotensin converting enzyme: 8.4 U/L
QuantiFeron TB gold test : positive
High resolution computed tomography scan chest :
non specific lesion

7. February 2012 Eale’s disease v/s presumed tuberculous vasculitis
Started on Oral prednisolone 1 mg/kg (60 mg/day)
Reviewed with chest physician: started on 2 drug anti TB Rx for 9 months.
High Intra ocular pressure on first visit: steroid responder ?? Started on anti glaucoma Rx

8. Feb 2012 – June 2012 Improvement in vision
Right eye 6/6 , N6 ; Left eye 6/9, N6
Activity reduced as compared to first visit.
Oral steroid tapered, anti glaucoma treatment continued

10. June 2012 complains of reduced vision in Left eye
Patient was on prednisolone 10 mg/day
Right eye
Left eye
BCVA
6/6; N6
3/60, N36
IOP 10 12
Anterior segment
quite
Vitreous cells ++
Fundus findings
Active vasculitis
Occlusive vasculitis with active retinitis with macular edema

12. June 2012 Fundus fluorescine angiography advised
Oral prednisolone dose hiked up
? ? other causes
Tests done:
C-ACNA: negative
P- ANCA: negative
HLA B51: negative

14. July 2012 Oral steroid dose increased
Left eye sectoral panretinal photocoagulation done around area of neovascularization
Anti TB treatment continued

15. August 2012 Sudden reduction in vision in Left eye Right eye Left eye
BCVA
6/6; N6
CF 1 mt; N36
IOP 10 12
Anterior segment
quite
Fundus findings
Resolving vasculitis
Vitreous hemorrhage

16. August 2012

17. August to September 2012 August 2012
- right eye : vision maintained; disease stabilized
- Left eye: non resolving vitreous haem
September 2012
- Left eye: Pars plana vitrectomy with membrane peeling with Endo laser application done under steroid cover
- Vitreous sample taken for Polymerase chain reaction(PCR) for Mycobacterium Tuberculosis

18. Diagnosis after vitrectomy
PCR for M. Tuberculosis : positive
Mantoux Test : positive
QuantiFeron TB gold test : positive
Presumed Tuberculous retinal periphlebitis

19. Problems Eales' disease v/s presumed tuberculous periphlebitis
Negative Mantoux test does not exclude Tuberculosis
QuantiFERON TB gold test : adds to the diagnosis
PCR of vitreous biopsy for MPB 64 diagnostic
Presumed tuberculous periphlebitis most common cause for Eales disease.

20. Follow-up: November 2012 continued on oral steroids tapering dose
Right eye
Left eye
BCVA
6/6; N6
6/9, N6
IOP 10 12
Anterior segment
quite
Fundus findings
Resolving vasculitis
continued on oral steroids tapering dose

21. Follow-up: November 2012

22. Follow-up: March 2013
Right eye
Left eye
BCVA
6/6; N6
6/7.5, N6
IOP 8 9
Anterior segment
WNL
quite
Fundus findings
Resolving vasculitis
Resolved vasculitis
continued on oral prednisolone 10mg/day: stopped after 2 months

23. Follow-up: March 2013

24. FFA done: no active vasculitis
Follow-up: November 2013
FFA done: no active vasculitis
Off oral steroids >6 months
Right eye
Left eye
BCVA
6/6; N6
IOP 8
Anterior segment
WNL
quite
Fundus findings
Resolved vasculitis
Laser marks with resolved vasculitis

25. Follow-up: November 2013

26. Discussion
Eales disease is defined as idiopathic inflammatory Retinal vasculitis with peripheral retinal revascularization primarily affecting the peripheral retina.
It has high male preponderance
Etiopathogenesis of Eales’ disease is still controversial and ill-understood.
Tuberculosis is considered to be the most important cause for eales disease as evidenced by molecular micro biological studies.

27. Conclusion
Treatment with anti tuberculous treatment along with oral steroids treatment is very useful especially in developing countries with high prevalence of tuberculosis
Prompt retinal photocoagulation of the area of neovascularization and capillary non perfusion helps in preventing the complications

28. Conclusion It is in the nature of the disease to have recurrences
Therefore it is prudent to have regular follow ups for early diagnosis of recurrence of vasculitis and complications like peripheral neovascularization and vitreaous hemorrhage