USEFULNESS OF PARS PLANA VITRECTOMY IN MANAGING ASYMPTOMATIC EYES OF EALES` DISEASE
AbstractBackground: Eales` disease is an idiopathic obliterative vasculopathy that commonly affects the peripheral retina of healthy young males characterized by recurrent vitreous haemorrhage. We did this study to evaluate the usefulness of Pars Plana vitrectomy in asymptomatic eyes of patients presenting with Eales` Disease. Methods: Fifty-five patients with Eales` Disease demonstrable on the basis of three mirror fundus exam and Florescein Fundus Angiography with vitreous hemorrhage underwent either Pan retinal photocoagulation or vitrectomy in a span of 3 years. Their fellow asymptomatic eyes were initially treated with laser photocoagulation and after being followed for six months, they were grouped into either progressive cases (Group A) comprising of eleven eyes that underwent early vitrectomy, or non-progressive cases (Group B) comprising forty-four eyes that did not undergo any further treatment. These cases were followed for at least three years (range 38-42 months). Results: Out of the eleven eyes of group A, seven (63.63%) showed regression of disease process as compared to only ten out of forty-four eyes (22.72%) in Group-B. Conclusion: Early vitrectomy in established cases of Eales` disease provides satisfactory results and helps in preventing complications, which are difficult to treat. Regular checkup of peripheral retina by triple mirror examination should be performed in all asymptomatic fellow eyes of Eales` disease to detect the disease process at an early stage and prevent further complications. KEYWORDS: Eales` disease, Retinal neovascularization, Retinal vasculitis, Vitreous hemorrhage, Vitrectomy
Biswas J, Sharma T, Gopal L, Madhavan HN, Sulochana KN, Ramakrishnan S. Eales` disease-An Update. Surv Ophthalmol 2002; 47 (3): 197-214.
Das T, Biswas J. Kumar A. Eales` disease. Indian J Ophthalmol 1994; 42: 3-18.
Gadkari SS, Kamdar PA, Jehangir RP. Pars plana vitrectomy in vitreous haemorrhage due to Eales`` disease. Indian J Ophthalmol 1992; 10: 35-7.
Patnaik B, Nagpul PN, Namperumalsamy P, Kalsi R. Eales` disease-clinical features, pathophysiology, etiopathogenesis. Ophthalmol Clin North Am 1998; 11: 601-17.
Abraham C, Baig SM, Badrinath SS. Eales` disease. Proc All India Ophthalmol Soc 1977; 33: 223-9.
Donders PC. Eales` disease. Doc Ophthalmol 1958; 12: 1-105.
Biswas J, Therese L, Madhavan HN. Use of PCR in detection of mycobacterium tuberculosis complex DNA from vitreous sample of Eales` Disease. Br J Ophthalmol 1999; 83: 994-6.
Kimura SJ, Carriker FR, Hogen MJ. Retinal vasculitis with intraocular haemorrhage. Classification and results of special studies. Arch Ophthalmol 1956; 56: 361-5.
Saxena S, Rajasingh J, Biswas S. Cellular immune response to retinal S-antigen and interphotoreceptor retinoid-binding protein fragments in Eales` disease patients. Pathobiology 1999; 67: 39-44.
Biswas J, Narain S, Roy S, Madhavan HN. HLA Association in Eales` disease. Invest Ophthalmol Vis Sci 1996; 36: S363.
Atmaca LS, Idli A, Gunduz K. Visualisation of retinal vasculitis in Eales` disease. Ocul Immunol Inflamm 1993;1: 49-54.
Renie WA, Murphy RP, Anderson KC. The evaluation of patients with Eales` disease. Retina 1983; 3 : 243-8.
Nagpal PN, Sharma RK, Joshi BS, Patel AM. Management of Eales` disease-analysis of 800 cases (1,214 eyes). Asia Pac J Ophthalmol 1998;10:11-7.
Badrinath SS, Gopal L, Sharma T. Vitreoschisis in Eales` disease: pathogenic role and significance in surgery. Retina 1999; 19: 51-4.
Theodossisadis G. Fluorescein angiography in Eales` disease Am J Ophthalmol 1970; 69: 271-7.
Jalali S, Das T. EALES` disease. In: Dutta LC, ed. Modern Ophthalmology. New Delhi: Jaypee Brothers Medical Publishers, 2000; 2: 704-5.
Obana A, Miki T, Matsumoto M. An experimental and clinical study of chorioretinal photocoagulation using a frequency-doubled Nd: YAG laser. Nippon Ganka Gakai Zasshi 1993; 97: 1040-6.
Oyakawa RT, Michels RG, Blase WP. Vitrectomy for non-diabetic vitreous hemorrhage. Am J Ophthalmol 1983; 96: 517-25.
Stephen CG, Robert PM. Eales` Disease. In : Jackobiec FA, Albert DM, eds. Principles and Practice of Ophthalmology: Clinical practice. Philadelphia: WB Saunders Company, 1994; 58: 791-5.
Shanmugam MP, Badrinath SS, Gopal L, Sharma T. Long term visual results of vitrectomy for Eales` disease complications. Int Ophthalmol 1998; 22: 61-4.
Gadkari SS, Kamdar PA, Jehangir RP, Shah NA, Adrianwala SD. Pars plana vitrectomy in vitreous hemorrhage due to Eales` disease. Indian J Ophthalmol 1992; 40:35-7.
Kumar A, Tiwari HK, Singh RP, Verma L, Prasad N. Comparative evaluation of early vs. deferred vitrectomy in Eales` disease. Acta Ophthalmol Scand 2000; 78:77-8.
Badrinath SS, Gopal L, Sharma T, Parikh S, Shanmugam MP, Bhende P, Biswas J. Vitreoschisis in Eales` disease: pathogenic role and significance in surgery. Retina 1999;19: 51-4.