A Multidisciplinary Approach to the Management of Eales Disease: A Case Report and Review of the Literature

Abstract

Eales disease manifests as an obliterative periphlebitis affecting the retina; it originates from the periphery and progresses posteriorly. It is characterized by retinal vessel wall inflammation, ischemia, and retinal neovascularization. In this report, we present the case of a 34-year-old male who attended our clinic with a sudden blurring of vision in his right eye. A diagnosis of bilateral retinal vasculitis with vitreal hemorrhage was ascertained in his RE. A dilated ocular fundus examination revealed perivenous sheathing of the peripheral vessels in both eyes. Fluorescein angiography indicated dye staining, vessel obliteration, capillary drop-out, areas of non-perfusion and the formation of new vessels. Laboratory tests revealed positive results for Borrelia; a PPD skin test and QuantiFERON TB assay were also positive. The patient underwent bilateral retinal laser pan-photocoagulation, followed by systemic treatment with oral steroids, cephazoline, isoniazid, azathioprine, and entecavir. The steroid dose was progressively reduced over 10 months; the treatment with azathioprine continues, as we are monitoring the patient over the long term. After 3 months, the vasculitis had regressed without any vitreal hemorrhage recurrence. Vision acuity improved from 0.4 to 1 in the patient’s right eye. A multidisciplinary approach, which included collaborative management with gastroenterology, infectious disease, pulmonology, and rheumatology specialists, was essential for the diagnosis, treatment, and long-term follow up of the patient.

A Review of Eales’ Disease and Mycobacterium tuberculosis

“…Beyond tuberculosis, which has been notably linked to the etiology of Eales’ Disease, further studies on rare case reports of patients presenting with complex medical histories and potentially associated diseases are warranted. As exemplified by Mercut et al, Eales’ Disease demands a multidisciplinary approach, involving collaboration among gastroenterology, infectious diseases, pulmonology, and rheumatology departments [ 45 ]. This multidisciplinary approach, involving diverse specialties, is helpful in diagnosing and formulating precise treatment schemes, particularly for patients with challenging medical conditions, such as those with immunosuppressive requirements.…”