Eales’ disease: epidemiology, diagnostic and therapeutic concepts

Abstract Background To describe the epidemiological traits, clinical characteristics, diagnostic procedures, therapeutic interventions and evolution in a large series of patients with diagnosis of Eales’ disease. Methods A clinical retrospective review of patients with Eales’ disease, evaluated and treated between April 2009 and April 2018, with a 1-year minimum follow-up. Thirty patients (59 eyes), were included. Age, sex, laboratory results (CBC, glycemia, protein electrophoresis, ACE levels) immunological profile and a Quantiferon-TB Gold Plus test were recorded. The patients were divided into groups according to their evolution, medical or surgical treatment, and visual outcomes. Results Seventeen male patients and 13 female patients were included, and their ages ranged from 14 to 35 years. The Quantiferon-TB Gold Plus test was positive in 25 patients. Twenty-eight patients had unilateral vitreous hemorrhage, 10 of whom presented with vasculitis and non-perfusion areas in the contralateral eye, 9 presented contralateral peripheral neovascularization and 9 had contralateral fibrovascular proliferation. The remaining 2 patients presented with a rhegmatogenous retinal detachment. In 6 patients, conservative treatment with intravitreal anti-VEGF injections and photocoagulation was performed after the hemorrhage cleared. Twenty-two patients, required vitrectomy, with good visual outcomes. Macular edema was found in 16 eyes, which responded to periocular and/or systemic corticosteroid therapy, except for 9 eyes that required intravitreal bevacizumab, with complete resolution in 7 eyes and partial resolution in 2 eyes. Conclusions Eales’ disease is a pathology of significant prevalence in our country. The distribution according to sex, tends to be equivalent. The etiology, even when it is not specifically determined, according to laboratory tests, confirms the probable immunologic response in the presence of Mycobacterium tuberculosis antigens. This is still a diagnosis of exclusion, and therefore, it is advisable to perform a complete laboratory work-up in each case. Timely application of laser and other medical treatments, help to avoid progression to more advanced stages and their complications. The surgical treatment of vitrectomy for vitreous hemorrhage, and/or tractional vitreous detachment yields good primary anatomical and functional outcomes. Secondary macular edema responds to periocular and intravitreal corticosteroids, and in refractory cases, the use of anti-VEGF therapy leads to an effective resolution.

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Change in Visual Acuity in Relation to Central Macular Thickness after Intravitreal Bevacizumab in Diabetic Macular Edema

Pakistan Journal of Ophthalmology ◽

10.36351/pjo.v36i3.1051 ◽

2020 ◽

Vol 36 (3) ◽

Author(s):

Muhammad Ali Haider ◽

Uzma Sattar ◽

Syeda Rushda Zaidi

Keyword(s):

Visual Acuity ◽

Macular Edema ◽

Diabetic Macular Edema ◽

Intravitreal Bevacizumab ◽

Macular Thickness ◽

Rank Test ◽

P Value ◽

Central Macular Thickness ◽

Anti Vegf ◽

Quasi Experimental

Purpose: To evaluate the change in visual acuity in relation to decrease in central macular thickness,after a single dose of intravitreal Bevacizumab injection.Study Design: Quasi experimental study.Place and Duration of Study: Punjab Rangers Teaching Hospital, Lahore, from January 2019 to June 2019.Material and Methods: 70 eyes with diabetic macular edema were included in the study. Patients having high refractive errors (spherical equivalent of > ± 7.5D) and visual acuity worse than +1.2 or better than +0.2 on log MAR were excluded. Central macular edema was measured in μm on OCT and visual acuity was documentedusing Log MAR chart. These values were documented before and at 01 month after injection with intravitrealBevacizumab. Wilcoxon Signed rank test was used to evaluate the difference in VA beforeand after the anti-VEGF injection. Difference in visual acuity and macular edema (central) was observed,analyzed and represented in p value. P value was considered statistically significant if it was less than 0.01%.Results: Mean age of patients was 52.61 ± 1.3. Vision improved from 0.90 ± 0.02 to 0.84 ± 0.02 on log MARchart. The change was statistically significant with p value < 0.001. Central macular thickness reduced from 328 ±14 to 283 ± 10.6 μm on OCT after intravitreal anti-VEGF, with significant p value < 0.001.Conclusion: A 45 μm reduction in central macular thickness was associated with 0.1 Log MAR unit improvementin visual acuity after intravitreal Bevacizumab in diabetic macular edema.

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Cystoid Macular Edema after Extracapsular Cataract Extraction Performed by Residents

Pakistan Journal of Ophthalmology ◽

10.36351/pjo.v36i3.1029 ◽

2020 ◽

Vol 36 (3) ◽

Author(s):

Adnan Alam ◽

Mohammad Idris ◽

Hassan Yaqoob ◽

Eemaz Nathaniel ◽

Syed Ittrat Hussain ◽

...

Keyword(s):

Macular Edema ◽

Cystoid Macular Edema ◽

Intravitreal Bevacizumab ◽

Cataract Extraction ◽

Hypertensive Retinopathy ◽

Extracapsular Cataract Extraction ◽

Retinal Degenerations ◽

Intravitreal Bevacizumab Injection ◽

Anti Vegf ◽

Central Subfield Thickness

Purpose: To determine the frequency and outcome of management of cystoid macular edema after extracapsular cataract extraction performed by residents.Study Design: Interventional case series.Place and Duration of Study: Lady Reading Hospital, MTI, Peshawar from Oct 2018 to Oct 2019.Material and Methods: Total 400 patients with mature cataract were included in our study. Patients having preexistingdisease such as uveitis, hypertensive retinopathy, diabetic retinopathy and retinal degenerations wereexcluded. All surgeries were performed by 4th year residents under supervision. Complicated cases before orduring surgery were excluded from the study. Cystoid macular edema cases were classified as follows; acuteoccurring within three months of cataract extraction and with duration fewer than 6 months, chronic persistingmore than 6 months. Patients were either managed conservatively or with anti-VEGF. All cases were followed for3 months or longer until resolution of cystoid macular edema.Results: Twenty patients developed cystoid macular edema out of which 16 patients (80%) improved withconservative treatment and 4 patients (20%) developed resistant cystoid macular edema. All four patients weregiven intravitreal bevacizumab injection monthly for three months. Our findings showed that best corrected visualacuity (BCVA) before injection ranged from 6/60 to 6/24. After three injections BCVA improved between 6/18 to6/6. Pre injection central subfield thickness (CSFT) was between 611 to 480 micron which improved to 272 -260micron after injections.Conclusion: Cystoid macular edema responds well to conservative treatment but resistant cases need repeatedinj of anti VEGF.

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Comparison of Intravitreal Bevacizumab versus Intravitreal Ranibizumab in Treatment Naive Macular Edema Patients (Real World Evidence in Pakistan)

Pakistan Journal of Ophthalmology ◽

10.36351/pjo.v37i2.1194 ◽

2021 ◽

Vol 37 (2) ◽

Author(s):

Hajra Arshad Malik ◽

Rayyan Sabih ◽

Hina Khan ◽

Aamir Asrar ◽

Muhammad Asif

Keyword(s):

Macular Edema ◽

Treatment Options ◽

Intravitreal Bevacizumab ◽

Functional Results ◽

Intravitreal Ranibizumab ◽

Macular Volume ◽

Anti Vegf ◽

Significant Difference ◽

Quasi Experimental ◽

Treatment Naïve

Purpose: To compare the short-term efficacy and safety of intraocular Ranibizumab and Bevacizumab in patients with treatment Naïve macular edema. Study Design: Quasi experimental study. Place and Duration of Study: Amanat Eye Hospital, from August 2018 to November 2019. Methods: Patients with macular edema confirmed with optical coherence tomography (OCT) or leakage on fluorescein angiography were included. Patients with NVE, PDR without macular edema and patients who switched to alternative anti-VEGF compounds prior to the completion of three consecutive monthly injections of their respective anti-VEGF or switched to other treatment options were excluded from the study. A thorough clinical examination was conducted including best corrected visual acuity (BCVA, intraocular pressure (IOP), anterior and posterior segment examination and OCT macula. The patients were then allocated to one of the two study arms (either Bevacizumab or Ranibizumab) based on the doctor’s input and patient affordability. All patients underwent three consecutive injections of the selected molecule at one month intervals. BCVA, CRT and macular volume were then recorded 04 weeks after the third injection. Results: A statistically significant mean vision gain was observed from baseline in both groups (p < 0.05). However, the change in BCVA was not significantly different between intravitreal Bevacizumab group and intravitreal Ranibizumab group (p > 0.05). Similarly, although there was improvement in CRT and macular volume in both groups but there was no statistically significant difference between the two. Conclusions: Treatment with intravitreal Bevacizumab and Ranibizumab injections cause statistically similar anatomical and functional results in cases of treatment naïve macular edema. Key Words: Bevacizumab, Ranibizumab, Macular Edema, Diabetic Retinopathy, Macular Degeneration, Retinal Vein Occlusion.

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Worsening Proteinuria Following Intravitreal Anti-VEGF Therapy for Diabetic Macular Edema

Journal of VitreoRetinal Diseases ◽

10.1177/2474126418815823 ◽

2018 ◽

Vol 3 (1) ◽

pp. 54-56 ◽

Cited By ~ 2

Author(s):

Jessie-Anne Kenworthy ◽

Justin Davis ◽

Varun Chandra ◽

J. Ben Clark ◽

Michael Desmond

Keyword(s):

Case Report ◽

Macular Edema ◽

Diabetic Macular Edema ◽

Intravitreal Bevacizumab ◽

Standard Of Care ◽

Systemic Effects ◽

Anti Vegf ◽

Antivascular Endothelial Growth Factor ◽

Growing Body ◽

Endothelial Growth Factor

Intravitreal antivascular endothelial growth factor (anti-VEGF) therapy is a standard of care for a variety of ophthalmological conditions. While the systemic use of these agents in oncology is well known to induce a number of renal-related adverse effects such as worsening hypertension and proteinuria, the ability of local intravitreal injections to cause similar side effects has traditionally been thought to be unlikely given the lower doses used. In this case report, we describe an 88-year-old woman who developed a sudden worsening of her previously stable proteinuria with the use of bilateral intravitreal bevacizumab injections for diabetic macular edema, with improvement in her proteinuria upon reduction to unilateral therapy. This case report adds to the growing body of literature that suggests that local anti-VEGF therapy may have the potential to induce adverse systemic effects, and clinicians who care for these patients should remain vigilant to the development of potential renal-related toxicity.

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Macular edema secondary to malignant Hypertension managed with Intravitreal Bevacizumab

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v11i1.25444 ◽

2019 ◽

Vol 11 (1) ◽

pp. 98-101

Author(s):

Abhinav Dhami ◽

Latha Vichu ◽

Parveen Sen

Keyword(s):

Macular Edema ◽

Vision Loss ◽

Intravitreal Bevacizumab ◽

Malignant Hypertension ◽

Visual Recovery ◽

Effective Treatment Option ◽

Blood Retinal Barrier ◽

Foveal Thickness ◽

Anti Vegf ◽

Sudden Decrease

Introduction: Intravitreal anti VEGF agents are used in a variety of retinal pathologies to decrease the VEGF levels resulting due to breakdown of the blood retinal barrier hence decrease the exudation from vessels which causes macular edema (ME). Case: A 61year old patient presented with sudden decrease in vision in both eyes with a history of systemic malignant hypertension leading to macular edema as documented on optical Coherence Tomography (OCT) in both eyes. The foveal thickness (FT)of 536 and 328 microns (μ) were observed in the right and left eye each. He was advised intravitreal anti vascular endothelial growth factor (VEGF) in both eyes and advised complete systemic evaluation with the physician. Following one month postintravitreal bevacizumab ( IVB) injection in right eye, marked visual improvement was noted with concomitant significant reduction in macular edema in both eyes. Observation: Single Bevacizumab injection with control of hypertension in our patient resulted in rapid resolution of the macular edema and early visual recovery. Intravitreal anti VEGF is an effective treatment option in eyes due to hypertensivemaculopathy especially to gain speedy visual recovery. Conclusion: The case gives a unique outlook to the course of ME in the single patient with malignant HTN with or without IVB injection. We believe that anti VEGF injections may result in rapid recovery in vision and minimize the risk of permanent vision loss in eyes with malignant hypertension.

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Dramatic Resolution of Recalcitrant Cystoid Macular Edema after Concurrent Intravitreal Injection of Bevacizumab and Triamcinolone

Medical hypothesis discovery and innovation in ophthalmology ◽

10.51329/mehdiophthalmol.829 ◽

2020 ◽

Keyword(s):

Macular Edema ◽

Triamcinolone Acetonide ◽

Cystoid Macular Edema ◽

Vision Loss ◽

Intravitreal Bevacizumab ◽

Visual Outcome ◽

Intravitreal Triamcinolone ◽

Concurrent Treatment ◽

Intravitreal Triamcinolone Acetonide ◽

Anti Vegf

Background: Cystoid macular edema (CME), a common complication of branch retinal vein occlusion (BRVO), is associated with a significant vision loss. Anti-vascular endothelial growth factor (anti-VEGF) therapy is the gold standard of treatment, while grid macular photocoagulation has also been used as an adjuvant in patients with CME secondary to BRVO. More recent efforts were successful by the use of intravitreal triamcinolone acetonide. We proposed a concurrent use of intravitreal triamcinolone acetonide and intravitreal bevacizumab in the treatment of CME secondary to BRVO. Case presentation: We described an 82-year-old female with a BRVO in the right eye who developed associated CME. Repeated injections of intravitreal bevacizumab and modified grid macular laser treatment were ineffective. A concurrent treatment with intravitreal bevacizumab and triamcinolone acetonide resulted in complete and dramatic resolution of CME with a favorable visual outcome. Optical Coherence Tomography (OCT) demonstrated a significant decrease in central subfield thickness (CST) from 764μm to 253μm, without any post-procedure complications or recurrence of macular edema with complete recovery of visual acuity at 6-month follow-up. Conclusion: Early concurrent treatment with intravitreal anti-VEGF therapy (e.g. intravitreal bevacizumab) and intravitreal triamcinolone acetonide is likely to be more effective than intravitreal anti-VEGF agents alone or grid macular photocoagulation in the management of CME associated with BRVO.

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Dramatic Resolution of Recalcitrant Cystoid Macular Edema after Concurrent Intravitreal Injection of Bevacizumab and Triamcinolone

Medical hypothesis discovery and innovation in ophthalmology ◽

10.51329/mehdiophthal1407 ◽

2020 ◽

Vol 9 (3) ◽

pp. 159-163

Author(s):

Kakarla V. Chalam ◽

Suzie Gasparian ◽

Moises Enghelberg

Keyword(s):

Macular Edema ◽

Triamcinolone Acetonide ◽

Cystoid Macular Edema ◽

Vision Loss ◽

Intravitreal Bevacizumab ◽

Visual Outcome ◽

Intravitreal Triamcinolone ◽

Concurrent Treatment ◽

Intravitreal Triamcinolone Acetonide ◽

Anti Vegf

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ROLE OF INTRAVITREAL BEVACIZUMAB IN EALES DISEASE WITH DENSE VITREOUS HEMORRHAGE

Retina ◽

10.1097/iae.0b013e3181f2a27f ◽

2011 ◽

Vol 31 (5) ◽

pp. 866-870 ◽

Cited By ~ 7

Author(s):

Sourabh Dileep Patwardhan ◽

Rajvardhan Azad ◽

Bhavin Mahendra Shah ◽

Yograj Sharma

Keyword(s):

Intravitreal Bevacizumab ◽

Vitreous Hemorrhage ◽

Eales Disease

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OCT angiography features associated with macular edema recurrence after intravitreal bevacizumab treatment in branch retinal vein occlusion

Scientific Reports ◽

10.1038/s41598-019-50637-8 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 2

Author(s):

Kwang-Eon Choi ◽

Cheolmin Yun ◽

Jaehyung Cha ◽

Seong-Woo Kim

Keyword(s):

Macular Edema ◽

Retinal Vein Occlusion ◽

Branch Retinal Vein Occlusion ◽

Intravitreal Bevacizumab ◽

Intravitreal Bevacizumab Injection ◽

Vein Occlusion ◽

Anti Vegf ◽

Bevacizumab Treatment ◽

Capillary Plexus ◽

Endothelial Growth Factor

Abstract We aimed to evaluate the relationship between the capillary abnormalities including nonperfusion area (NPA) in optical coherence tomography angiography (OCTA) images and the recurrence of macular edema (ME) secondary to branch retinal vein occlusion (BRVO) after intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF; bevacizumab). The records of 40 patients who underwent intravitreal bevacizumab injection for ME secondary to BRVO and had at least six months of follow-up were reviewed. Central retinal thickness (CRT; μm) and macular edema type were evaluated prior to treatment. After ME resolution, nonperfusion areas in the 1 mm (NPA1) and 1–3 mm (NPA3) zones on the Early Treatment Diabetic Retinopathy Study (ETDRS) circle within the superficial capillary plexus (SCP) and deep capillary plexus (DCP) were measured using OCTA images. Furthermore, other microvascular abnormalities in the both SCP and DCP were compared between groups. ME recurred in 25 of 40 (62.5%) eyes. The NPA1 of the SCP and DCP (p = 0.002, 0.004, respectively), NPA3 of the SCP and DCP (p = 0.002, 0.008, respectively), and initial CRT (p = 0.022) differed significantly between eyes with and without ME recurrence. In multivariate logistic regression analyses, the NPA1 of the DCP (OR: 344.718; p = 0.029) and NPA3 of the SCP (OR: 4.072; p = 0.018) were significantly associated with ME recurrence. Other microvascular abnormalities were not significantly different between two groups. The central NPA and parafoveal NPA of the SCP in OCTA images correlated strongly with ME recurrence in BRVO patients after intravitreal anti-VEGF injection.

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Comparative Eye Effect of Unilateral Intravitreal Bevacizumab, Ranibizumab, and Aflibercept for Diabetic Macular Edema

Journal of VitreoRetinal Diseases ◽

10.1177/2474126418819059 ◽

2019 ◽

Vol 3 (2) ◽

pp. 86-89

Author(s):

Brett Malbin ◽

Harshad P. Patel ◽

Yuguang He ◽

Kim Le ◽

Xihui Lin

Keyword(s):

Macular Edema ◽

Diabetic Macular Edema ◽

Intravitreal Bevacizumab ◽

Fellow Eye ◽

Anti Vegf ◽

Central Subfield Thickness ◽

Bilateral Diabetic Macular Edema ◽

Pharmacologic Treatments ◽

Endothelial Growth Factor ◽

Significant Therapeutic Effect

Purpose: The purpose of this article is to compare the fellow-eye effect of unilateral intravitreal antivascular endothelial growth factor (anti-VEGF) treatment (bevacizumab, ranibizumab, and aflibercept) in patients with bilateral diabetic macular edema (DME). Methods: A retrospective review was conducted of hemoglobin A1c-matched groups receiving unilateral anti-VEGF injections (1.25 mg bevacizumab, 0.5 mg ranibizumab, and 2 mg aflibercept) in which the second eye had subclinical DME. Two main outcome measures evaluated were central subfield thickness (CST) on optical coherence tomography and best-corrected visual acuity (BCVA). Patients were excluded if they had poor BCVA (< 20/100) or had received laser, vitrectomy, filtering surgery, or pharmacologic treatments in the 3 months prior in the noninjected eye. Results: A total of 2073 total intravitreal anti-VEGF injections for DME were reviewed and 94 met the inclusion criteria: 40 bevacizumab, 33 ranibizumab, and 21 aflibercept. At 1 month, the CST of the fellow eye in the bevacizumab group had a statistically significant decrease (296.82 µm to 292.46 µm, P = .01) while both the ranibizumab and aflibercept groups trended toward worsening edema. When compared to ranibizumab and aflibercept, the CST in the noninjected eye in the bevacizumab group had improvements of –15.03 µm and –13.47 µm, respectively ( P < .019). When bevacizumab was switched to ranibizumab or aflibercept, the edema in the fellow eye worsened by +49.60 µm and +5.50 µm, respectively. Conclusion: Bevacizumab injection has a statistically significant therapeutic effect in the fellow eye when compared to those treated with ranibizumab and aflibercept. The edema in the fellow eye worsened when injection in the primary eye was switched away from bevacizumab.

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