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

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: 472-822. Saxena S, et al. Indian J Ophthalmol 2007; 55: 267-9

Inflammatory stage

Retinal Vasculitis

Ischemic stage

Retinal Vascular obliteration

Proliferative stageRetinal NV or on Optic disc,

recurrent VH w/wo RD

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: 197-2142. Atmaca LS, et al. Ocular Immunology and Inflammation 2002; 10: 213-21

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

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

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

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

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%)

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%)

8 patients (10 eyes) were lost to follow-

up on treatment

after scatter photocoagulation followed by PRP photocoagulation

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

Stage Number Mean initial VA (±SD)

Mean final VA(±SD)

P value

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

TRD, complicated cataract,VH and CME.

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