Progression of Eales’ disease post-partum and long-term follow-up: a case report

Abstract

BackgroundEales’ disease is a difficult to treat idiopathic form of retinal vasculitis. We present such a case with peculiar epidemiology in which the only efficient therapeutic approach in order to maintain functional vision was repeated intravitreal dexamethasone implants (Ozurdex®). To the best of our knowledge this is the first report of this kind in the literature.Case presentationThis is the case of a 40-year-old white woman presenting in 2008 with recurrent floaters accompanied by blurring of vision in her right eye and severe visual loss in her left eye caused by retinal detachment; her age at presentation was 30 years. A diagnosis of Eales’ disease was made by exclusion. She was stable until 2011 after childbirth (cesarean section). Despite aggressive systemic treatment with steroids, azathioprine, and mycophenolate mofetil, progression of the disease was noted that could only be controlled with repeated intravitreal dexamethasone implants (Ozurdex®) injected in her right eye. Her left eye underwent vitrectomy with silicone oil tamponade for tractional retinal detachment with satisfactory anatomical result but vision was limited to light perception.ConclusionsIn our case the systemic therapy was much less effective than the intravitreal sustained-release dexamethasone implant (Ozurdex®) for reducing recurrences and halting disease progression. We believe that recurrent and severe cases could benefit from this addition to the classic treatment armamentarium.Electronic supplementary materialThe online version of this article (10.1186/s13256-018-1768-y) contains supplementary material, which is available to authorized users.

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

“…Ivanescu et al described the case of a 40-year-old woman diagnosed with bilateral Eales disease whose condition rapidly worsened postpartum, with recurrent vitreous hemorrhages and a limited response to systemic treatment. In this case, the disease was controlled using intravitreal sustained-release dexamethasone implants (Ozurdex) [ 13 ].…”

“…The treatment of choice in more advanced cases when the disease is in the proliferative stage is laser photocoagulation [ 13 , 14 ]. The aim of the laser treatment is to induce the regression of neovascularization in the areas of retinal non-perfusion.…”

Clinical Characteristics of Eales Disease and the Efficacy of Different Interventions for Neovascular Complications

“…The management of Eales disease is based on its stage. 7 Steroids are the primary agents used most frequently in the inflammatory stage, 8,9 whereas photocoagulation is the mainstay treatment in the ischemic and neovascularization stage. 10 It is reported that retinal ischemic stimulates the production of vascular endothelial growth factor (VEGF), which leads to neovascularization and fibrous proliferation.…”