Characteristics and treatment outcome of Eales’ disease: a retrospective study

1. Rumita S. Kadarisman¹, Gitalisa Andayani², Mario Hutapea2
¹AINI – Prof.DR.Isak Salim Eye Hospital
²Dept of Opthalmology, Cipto Mangunkusumo Hospital
University of Indonesia
JAKARTA, INDONESIA
12th EURETINA Congress, 6-9 September 2012, Milan,Italy

2.  Eales’ disease  idiopathic inflammatory retinal
vasculopathy that primarily affects the peripheral
retina of adults
◦ 3 hallmark signs: retinal phlebitis, peripheral
non-perfusion & retinal neovascularization (NV)1
 Immune mediated mechanism & enhanced
oxidative stress have been proposed in the
etiopathogenesis of this condition2
 In developed countries, rarely
 In India, most commonly reported
 In Indonesia, not documented until
now
1. Das T, et al. Eye 2010; 24: 472-82
2. Saxena S, et al. Indian J Ophthalmol 2007; 55: 267-9

3. Inflammatory stage
Retinal Vasculitis
Ischemic stage
Retinal Vascular obliteration
Proliferative stage
Retinal NV or on Optic disc,
recurrent VH w/wo RD

4.  Treatment
◦ In the Inflammation stage, to reduce retinal vasculitis &
vitritis  corticosteroids
◦ In the ischemic stage, to reduce risk of VH resulting
from NV  laser photocoagulation, with or w/o
cryoablation
◦ In the Proliferative stage , to remove non-resolving VH &
membranes  vitrectomy (w Laserphotocoagulation)
◦ Intravitreal steroids or anti-VEGF have shown promising
results in patients with inflammation &
macular edema1
 Prognosis usually depends on degree of VH,
macular circulatory failure & proliferative
retinopathy2
1. Biswas J, et al. Surv Ophthalmol 2002; 47: 197-214
2. Atmaca LS, et al. Ocular Immunology and Inflammation 2002; 10: 213-21

5. A retrospective study to
evaluate the characteristics &
treatment outcome of Eales’
Disease in Jakarta, Indonesia

6.  Medical records of patients previously diagnosed
with Eales’ Disease between 1999 and 2011 at
national referral hospital (Cipto Mangunkusumo
Hospital) and a private eye hospital (Prof Isak Salim
Aini Eye Hospital) Jakarta, were evaluated
 Only those patients with a minimum 4 week follow-
up were included in this study

7.  All the eyes were staged according to the new
classification system for Eales’ disease:
◦ Stage 1: Periphlebitis of small (1a) and large (1b) caliber
vessels with superficial hemorrhages
◦ Stage 2a: Capillary nonperfusion
◦ Stage 2b: Neovascularization elsewhere/of the disc
◦ Stage 3a: Fibrovascular proliferation
◦ Stage 3b: Vitreous hemorrhage
◦ Stage 4a: Traction/combined rhegmatogenous retinal
detachment
◦ Stage 4b: Rubeosis iridis, neovascular glaucoma,
complicated cataract, and optic atrophy

8.  34 patients (63 eyes) were enrolled
 Mean age: 30.57 (range: 19-48) years old
 Sex
◦ Male: 27 patients (79.41%)
◦ Female: 7 patients (20.59%)
 Laterality
◦ 92.1% bilateral, 7.9% unilateral

9. Disease stage Proportion (n=63 eyes)
1b 11 (17.5%)
2a 6 (9.5%)
2b 5 (7.9%)
3a 8 (12.7%)
3b 27 (42.9%)
4a 6 (9.5%)

10. 8 patients (10 eyes)
were lost to follow-
up on treatment
Treatment type Proportion (n=53 eyes)
No treatment (observation) 3 (5.67%)
Medical treatment 7 (13.20%)
Laser photocoagulation 36 (67.92%)
Vitrectomy 6 (11.32%)
Laser+medical treatment 1 (1.89%)
after scatter photocoagulation followed by  PRP photocoagulation

11.  Of 53 eyes, 4 eyes were lost to follow-up 
n=49 eyes
 Mean VA improved from Snellen Chart 0.49±0.41
to 0.66±0.38 (decimal)  statistically significant
difference (p=0.000, Wilcoxon-signed rank test)
 28 eyes (44%) improved, 19 eyes (30.2%) remained
stable, 2 eyes (3.2%) worsened
 Mean follow-up 7.12 (range= 4-20) weeks

13. Stage Number Mean initial VA Mean final VA P value
(±SD) (±SD)
1b 8 0.86 (±0.21) 0.91 (±0.15) 0.109*
2a 6 0.76 (±0.38) 0.83 (±0.34) 0.317*
2b 4 0.67 (±0.30) 0.80 (±0.28) 0.080^
3a 4 0.52 (±0.56) 0.55 (±0.52) 0.180*
3b 23 0.28 (±0.34) 0.56 (±0.40) 0.000*
4a 4 0.36 (±0.42) 0.41 (±0.38) 0.186^
^ : paired t-test, *: Wilcoxon signed rank test

14. TRD, complicated cataract,VH and CME.

15.  Significant improvement in visual acuity was
observed in the majority of eyes with Eales’ disease
following treatment
 Periodic follow-up of at least 4 weeks, adequate
medical & laser treatment for VH, vitrectomy with
additional laser photocoagulation for nonclearing
VH has been shown to improve the prognosis in
these patients