A Series of Ocular Tuberculosis Cases from A Rural Tertiary Care Center in West Bengal

Tuberculosis in Eye can have diverse presentations leads to diagnostic difficulty. If no extra-ocular tubercular lesions are found then it becomes a challenge to diagnose & treat. Here authors present 6 cases of Ocular Tuberculosis without any associated extra-ocular tubercular lesions. One case of tubercular anterior uveitis, eales disease, solitary Choroidal Tuberculoma, bilateral multiple Choroidal Tuberculoma, multifocal & serpiginous like Choroiditis are presented here. All of them were resolved with first line anti-tubercular regimen and corticosteroids. Authors recommend initial visual assessment for all Tuberculosis cases to diagnose & treat hidden cases of Ocular Tuberculosis which may be sight threatening.

Wide-field angiography for diagnosis and follow-up of Eales disease: a case series / Angiografia de amplo campo para diagnóstico e monitoramento da doença de Eales: série de casos

ABSTRACT Wide-field angiography enables assessing peripheral areas with better quality and gives greater deep focus, which improves the image periphery. Some studies have proposed the usefulness of these angiographic systems in inflammatory diseases of the retina. However, few studies have evaluated this technique in Eales disease. We present a case series in which 5 eyes of 3 patients with Eales disease were evaluated by using retinal fluorescein angiography with 30º, 50º, and 150º lenses in a laser-scanning ophthalmoscope. These cases highlight the usefulness of wide-field fluorescein angiography in the diagnosis and follow-up of peripheral ischemic retinal areas in Eales disease, which enables better follow-up than possible with conventional fluorescein angiography images.

RESUMO A angiografia de campo amplo permite avaliar áreas periféricas com melhor qualidade e proporciona maior foco profundo, melhorando a imagem da periferia. Alguns estudos têm proposto a utilidade desses sistemas angiográficos nas doenças inflamatórias da retina. No entanto, poucos estudos avaliaram esta técnica na doença de Eales. Apresentamos uma série de casos em que 5 olhos de 3 pacientes com doença de Eales foram avaliados usando angiografia de fluoresceína da retina com lentes de 30º, 50º e 150º em um oftalmoscópio de varredura a laser. Esses casos destacam a utilidade da angiografia com fluoresceína de campo amplo no diagnóstico e no acompanhamento das áreas isquêmicas periféricas da retina na doença de Eales, permitindo um melhor acompanhamento do o possível com imagens por angiofluoresceinografia convencional.

Spectral domain optical coherence tomography evaluation of macular changes in Eales disease

Purpose: The purpose of the study was to describe macular changes in treatment-naïve eyes with Eales disease using spectral domain optical coherence tomography (SD-OCT). Methods: A cross-sectional study was done on 79 eyes of 66 patients with Eales disease. Best-corrected visual acuity (BCVA), slit-lamp biomicroscopy (SLB), indirect ophthalmoscopy, fundus fluorescein angiography (FFA), and quantitative (central macular thickness [CMT]) and qualitative analysis on SD-OCT were performed. Results: Forty-six (58.2%) eyes had macular involvement as assessed with SD-OCT, while in 33 (41.8%) eyes, macula was not affected. Macular edema was the most common feature when macula was affected followed by epiretinal membrane. Mean CMT was higher (315.3 ± 102.3 ?m) in eyes with macular involvement than those without it (243.8 ± 19.3 ?m). Eyes with active vasculitis involving larger vessels and neovascularization had greater chance of macular involvement. SLB and FFA alone missed 28.3% and 50% eyes with macular abnormalities on SD-OCT, respectively. Conclusion: While the clinical description of Eales disease points mainly to a peripheral location, macular involvement can be commonly picked up when SD-OCT is used. Macular involvement when present is associated with a poorer BCVA.

Vasculitis retinal / Retinal vasculitis

La vasculitis retinal es una enfermedad inflamatoria que amenaza la visión y afecta los vasos retinales (capilares, venas y arterias). Puede ocurrir como una condición idiopática o como complicación de enfermedades infecciosas y neoplásicas o en asociación con enfermedades sistémicas inflamatorias. Sus manifestaciones clínicas típicas incluyen revestimiento perivascular, envainamiento, filltración vascular y oclusión. Puede estar asociada con signos de isquemia retinal (puntos algodonosos y hemorragias intraretinales). Es clasificada en diferentes estadíos: inflamación, isquemia, neovascularización y complicaciones. En su diagnóstico es importante la biomicroscopia, la oftalmoscopia del segmento posterior y la prueba de angiografía fluoresceínica. Se presenta un paciente de 30 años con buena historia de salud anterior. El paciente comenzó con enrojecimiento del ojo izquierdo y la observación de flotadores en ambos ojos. Fue examinado y los signos clínicos fueron descritos en el examen oftalmológico. El examen del fondo de ojo con lente de 90 dioptrias y el oftalmoscopio binocular indirecto fue realizado para un cuidadoso examen. La retinografía del fondo y las imágenes del test de angiografía y otros estudios complementarios indicados permitieron conocer que presentaba una vasculopatía obliterativa retinal ideopática (Enfermedad de Eales), y el diagnóstico diferencial fue discutido. El tratamiento indicado fue la fotocoagulación con láser y evaluar la indicación de los estudios bioquímicos del cultivo del vítreo, por antígenos de leucocito humano, factor de crecimiento endotelial vascular e interleukinas que han sido observados en este examen(AU)

Retinal vasculitis is an inflammatory disease that threatens vision and affects retinal vessels (capillaries, veins and arteries). It may occur as an isolated idiopathic condition and as a complication of infective or neoplastic disorders, in association with systemic inflammatory diseases. Typical clinical manifestations including perivascular sheathing or cuffing, vascular leakage and occlusion. It may be associated with signs of retinal ischemia (cotton-wool spots and intra-retinal hemorrhage). It is classified into different stages: lnflamation, ischemia, neovascularization and complications. In the diagnosis, biomicroscopy and ophtalmoscopic of the posterior segment and fluorescein angiography test are important. A case report is presented of a 30-year-old male patient with a history of good health. In October 2015 the patient had started out with reddening of his left eye and the viewing of floaters with both eyes. Funduscopy was performed with a 90-dioptric lens and a binocular indirect ophthalmoscope. Fundus retinography, angiographic imaging and other complementary studies revealed an idiopathic obliterative retinal vasculopathy (Eales disease). The treatment indicated was photocoagulation, as well as a recommendation to evaluate the biochemical studies of the vitreous culture, since the test had found human leukocyte antigens, vascular endothelial growth factor and interleukins(AU)

Ultra‑wide field angiography in the management of Eales disease.

Aims: This study aims to evaluate the use of ultra‑wide field (UWF) angiography in patients with Eales disease (ED). Settings and Design: Prospective observational case series in tertiary eye care center. Subjects and Methods: This study involved 17 patients diagnosed with ED, who underwent UWF fluorescein angiography. The angiograms were analyzed to look for additional information as compared to Early Treatment Diabetic Retinopathy Study seven standard field. The impact of this information in the management of patients was analyzed. Results: 24 eyes of 17 patients with mean age of 26.3 years were diagnosed with ED and underwent UWF angiography. UWF fluorescein angiography was helpful in the documentation of peripheral retinal changes (in 67% of eyes), exact localization of capillary nonperfusion (CNP) (in 54% of eyes), and in determination of vascular involvement (in 21% of eyes). In 33% of eyes, immediate treatment plan changed because of changes picked up on UWF angiography. Conclusions: UWF angiography helped in the better documentation, exact quantification, and location of CNP areas and better determination of disease activity. UWF imaging may play an important part in the management of patients with ED.

Association of mycobacterium tuberculosis in the causation of Eales' disease: An institutional experience.

Background: Eales’ disease is an idiopathic retinal vasculitis characterized by retinal infl ammation, ischemia, and neo-vascularisation. It frequently causes massive vitreous haemorrhage and retinal detachment leading to blindness. Although the exact etiology is unknown, this condition is considered to be a consequence of hypersensitivity reaction to tubercular protein due to previous Mycobacterium tuberculosis (M. tuberculosis) infection. This study is aimed at the detection of association of M. tuberculosis in patients with Eales’ disease. Materials and Methods: A prospective case-control study was undertaken in 65 clinically diagnosed cases of Eales’ disease. Patients with proliferative diabetic retinopathy, neo-vascular proliferation, macular oedema, premacular fi brosis and tractional retinal detachment were taken as controls. M. tuberculosis DNA was detected (MPT64 gene by polymerase chain reaction, PCR) in patients with Eales’ disease. Clinical symptoms along with tuberculin skin test (TST) and erythrocyte sedimentation rate (ESR) were used as gold standard for comparing results of PCR. Result: PCR positivity was found in 12 (38.7%) patients with Eales’ disease. The PCR positivity was signifi cantly associated with the patients with high TST reading and high ESR values. Conclusion: Patients with a high TST reading and ESR value and a positive PCR in vitreous samples have a high likelihood of having M. tuberculosis as an etiology.

Central Retinal Vein Occlusion Occurrence in an Eales Disease Patient

PURPOSE: To report the occurrence of central vein occlusion in an Eales disease patient. CASE SUMMARY: A 23-year-old man presented with decreased left eye visual acuity and was diagnosed with bilateral Eales disease after ophthalmic evaluations. The patient received laser photocoagulation and visual acuity in his left eye improved 1 month after treatment. He was followed up regularly for 3 years and had no specific eye problems. Subsequently, the patient visited our clinic because of visual disturbance in his right eye. The patient's visual acuity was 0.6 in his right eye, and 1.0 in his left eye. On right eye fundus examination, there were multiple flame shape hemorrhages and retinal vascular tortuosity was observed. Arteriovenous transit time was extended on fluorescein angiography. Therefore, the patient was diagnosed with central retinal vein occlusion and underwent an internal medical examination to reveal a possible systemic cause of the central retinal vein occlusion; however, there were no systemic problems. Macular edema was observed on optical coherence tomography and the patient received an intravitreal bevacizumab injection. Six months after treatment, the right eye visual acuity and macular edema improved. CONCLUSIONS: Reports of branched retinal vein occlusion on the peripheral retina are common in Eales disease patients. However, the authors experienced and report a case of central retinal vein occlusion occurring in Eales disease.

Total antioxidant capacity in Eales’ disease, uveitis & cataract.

Background & objectives: The human system possesses antioxidants that act harmoniously to neutralize the harmful oxidants. This study was aimed to evaluate the serum total antioxidant capacity (TAC) as a single parameter in Eales’ disease (ED) and in an acute inflammatory condition such as uveitis and in cataract which is chronic, compared to healthy controls. Methods: The TAC assay was done spectrophotometrically in the serum of Eales’ disease cases (n=20) as well as in other ocular pathologies involving oxidative stress namely, uveitis and cataract (n=20 each). The oxidative stress measured in terms of TBARS, was correlated with the TAC. Individual antioxidants namely vitamin C, E and glutathione were also estimated and correlated with TAC. Results: TAC was found to be significantly lower in Eales’ disease with active vasculitis (0.28 ± 0.09 mM, P<0.001), Eales’ disease with healed vasculitis (0.67 ± 0.09 mM), uveitis (0.46 ± 0.09 mM, P<0.001) and cataract (0.53 ± 0.1 mM, P=0.001) compared to the healthy controls, with a TAC level of 0.77 ± 0.09 mM. The TAC was found to correlate positively with vitamin E levels (P=0.05), GSH (P=0.02) but not with vitamin C, as seen in ED cases. In ED cases supplemented with vitamin E and C, there was a significant increase in the TAC level (P=0.02). Interpretation & conclusions: The TAC measurement provided a comprehensive assay for establishing a link between the antioxidant capacity and the risk of disease as well as monitoring antioxidant therapy. This method is a good substitute for assay of individual antioxidants as it clearly gives the status of the oxidative stress in the disease process.

The Effect of Intravitreal Bevacizumab Injection in Eales' Disease

PURPOSE: To report on 2 cases of Eales' disease that were successfully regressed with laser photocoagulation and intravitreal bevacizumab (Avastin; Genetech, Inc, San Francisco, California, USA) injection. CASE SUMMARY: Two male patients (30 years and, 40 years of age,) with a history of recurrent vitreous hemorrhage were diagnosed with Eales' disease. The 2 patients had peripheral retina neovascularization and active phlebitis in fundus fluorescein angiography. No other findings were observed in their eyes in the general examination. Scatter laser photocoagulation and intravitreal bevacizumab injection were performed. After 1 month follow-up, neovascularization completely regressed. There was no complication or recurrent vitreous hemorrhage at the 1 year follow up. CONCLUSIONS: Intravitreal bevacizumab injection, as combination treatment of laser photocoagulation, may be helpful in the regression of neovascularization due to Eales' disease.

Epidemiology study of Eales disease and its risk factors in healthy young men / 吉林大学学报(医学版)

0. 05), and there seemed to have some statistical correlation between the incidence of Eales disease and PPD (P

Observation of the Effect of the Photocoagulation and Vitrectomy Treatment on Eales Disease / 中国医师杂志

Objective To evaluate the effect of argon laser photocoagulation (photocoagulation group) and endolaser photocoagulation during vitrectomy (vitrectomy group) on the eyes with Eales disease by fundus fluorescein angiography(FFA) and visual acuity (VA).Methods Sixty-seven eyes with Eales were treated by photocoagulation and 31 eyes with Eales were treated by vitrectomy. The changes of FFA and VA before and after treatment were observed.Results In the photocoagulation group, retinal non-perfusion disappeared in 31eyes(55 4%),alleviated in 17eyes(30 4%),unchanged in four eyes(7 1%)and deteriorated in four eyes(7 1%).Retinal neovascularization disappeared in 30 eyes(50 8%),alleviated in 19 eyes (32 2%),remained in six eyes(10 2%)and deteriorated in four eyes(6 8%).The first FFA after treatment, non-perfusion was existed in 25 eyes in photocoagulation group, and only was existed in two eyes in vitrectomy group.Neovascularization was existed in 29 eyes in photocoagulation group, and was existed in three eyes in vitrectomy group.The best visual correction(VA≥3 0) in photocoagulation and vitrectomy groups respectively was 30 eyes and zero eye before treatment,and after treatment respectively was 47 eyes and five eyes.There were 54 eyes and 11 eyes with VA≥0 05 in photocoagulation and vitrectomy groups respectively before treatment,and 60 eyes and 20 eyes with VA≥0 5 respectively after treatment.Conclusions The better result of FFA in vitrectomy group was related to the sufficient photocoagulation by endolaser. The higher rate of low vision in vitrectomy group was related to the impairment of macula by large amount of vitreous hemorrhages,retina detachment and vitrectomy. So the patients with Eales should be checked by FFA as early as possible.If the patients had the indicator to be treated by laser,they should be treated early and rechecked by FFA,to avoid the visual function harm by repeated vitreous hemorrhage due to incomplete treatment.

Association of human leucocyte antigen-DRB and -DQB alleles with Eales′ disease / 中华眼底病杂志

0.05). Conclusions In han-nationality people in Northern China, DRB1*04 is positively associated with Eales′ disease, suggesting that DRB1*04 may confer a major influence on Eales′ disease. Turbulence of immune function begotten by infect-agents attack may occur in the individuals with Eales′ disease due to the specific hereditary diathesis of HLA, which may cause the occurrence and development of Eales disease.

Eales Disease Accompanied with Branch Retinal Vein Occlusion

Eales disease is an uncommon idiopathic vasoproliferative retinal disease that primarily affects the peripheral retina. We experienced a 17-year-old male patient who was referred to our clinic because of retinal hemorrhage at the superior temporal quadrant of his left eye. After excluding other causes of branch retinal vein occlusion with medical evaluation, the primary branch retinal vein occlusion was diagnosed. During the follow-up period, retinal vasculitis developed in the peripheral retina of his both eyes along with rapid development of the neovascularization in the left eye. Eales disease was diagnosed. In spite of scattered laser photocoagulation, vitreous hemorrhage eventually occurred, requiring pars plana vitrectomy. We emphasize the occurrence of the branch retinal vein occlusion in young patient with Eales disease.

THE CURE EFFECT OF VITRECTOMY IN PATIENTS WITH EALES DISEASE / 解放军医学杂志

cases of vitreous haemorrhage secondary to Eales′ disease were selected for vitrectomy. According to the duration of vitreous haemorrhage, the patients were divided into two groups : Group 1 (20 eyes)-early vitrectomy group with a duration between 3 to 6 months; Group 2(20 eyes)-deferred vitrectomy group with a duration of more than 6 months . All the patients were followed up for a minimum period of 3 months following vitrectomy. The eyes in Group 1 showed a preoperative ultrasonic picture of complete posterior detachment, a final visual acuity of 0.6 or better in 13(65%) was achieved in mild vitreous organization on kinetic echography. Poor visual outcome in the deferred group was secondary to cystoid macular oedema, macular scar, macular pucker formation and macular degeneration. Improved visual outcome in the early vitrectomy group is probably due to haemorrhage and its products which have no time to damage the macula and to advance into macular traction and cystoid macular oedema.