Full panretinal photocoagulation and early vitrectomy improve prognosis of retinal vasculitis associated with tuberculoprotein hypersensitivity (Eales' disease).
OBJECTIVE
Eales' disease is an uncommon vasoproliferative retinal disease affecting otherwise healthy young men that is characterised by obliterative retinal periphlebitis, with sequelae such as recurrent vitreous haemorrhage and traction retinal detachment. This study was undertaken to determine whether visual prognosis of Eales' disease could be improved by appropriate medical and surgical treatment.


METHODS
The authors retrospectively studied 30 patients (46 eyes) who were treated from 1992 to 2001. Recorded data included patient age, sex, race, medical history, medications, results of the ophthalmological examination, results of diagnostic laboratory evaluation, and details of systemic and surgical treatments. The mean follow up was 10.6 months.


RESULTS
19 patients (23 eyes) who presented with active periphlebitis received systemic steroids and antituberculous therapy. Extensive full panretinal photocoagulation was performed in 21 eyes that presented with new vessel formation and peripheral capillary closure with or without vitreous haemorrhage. Vitrectomy and endolaser panretinal photocoagulation was necessary in 15 eyes, for severe non-clearing vitreous haemorrhage in 11 eyes and vitreous haemorrhage with traction retinal detachment in four eyes. Complete regression of the disease was achieved in all eyes. Vitrectomy resulted in a significant visual improvement with 14 of the 15 eyes (93.3%) achieving > or =20/200 visual acuity. Overall, the distribution of visual acuities among eyes improved from presentation to final follow up, with 36.4% of eyes having 20/40 or better acuity at presentation compared with 63.6% of eyes by final follow up.


CONCLUSIONS
These results suggest that aggressive treatment of Eales' disease with systemic steroids and antituberculous therapy, full panretinal photocoagulation and early vitrectomy, when necessary, may result in improving the anatomic and visual outcome.
El-Asrar
A M Abu
AM
Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia. abuasrar@ksu.edu.sa
Al-Kharashi
S A
SA
D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D001426:Bacterial Proteins / Q000276:immunology*; D005123:Eye / Q000098:blood supply; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D006967:Hypersensitivity / Q000150:complications* / Q000188:drug therapy; D008028:Light Coagulation; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D031300:Retinal Vasculitis / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014821:Vitrectomy; D014823:Vitreous Hemorrhage / Q000150:complications
D000995:Antitubercular Agents; D001426:Bacterial Proteins; C030960:tuberculoprotein, Mycobacterium tuberculosis; D011241:Prednisone