Treatment Outcomes in Eales’ Disease with Vitreous Hemorrhage at Tertiary Center in Southern Thailand

Objective: To assess the anatomical and functional outcomes of Eales’ disease with secondary vitreous hemorrhage after conservative treatment and/or pars plana vitrectomy (PPV). Material and Methods: A retrospective chart review of patients, diagnosed with Eales’ disease, at Songklanagarind Hospital from January 2003 to December 2017 was performed. Thirty-two eyes, from 28 patients, with secondary vitreous hemorrhage underwent conservative treatment and/or PPV; depending on the degree of vitreous hemorrhage, clinician consideration and patient’s decision. Results: Twenty-five eyes, with low-grade (grade 1-3) and dense (grade 4) vitreous hemorrhage, initially underwent conservative treatment; in which 64.0% achieved final best corrected visual acuity (BCVA) ≥20/70 and 56.0% achieved final BCVA ≥20/40 with complete resolution of vitreous hemorrhage. However, 8 eyes eventually required additional PPV as a result of non-resolving vitreous hemorrhage. Alternatively, 7 eyes with dense vitreous hemorrhage (grade 4) at the presentation, preferred PPV as primary treatment, which resulted in final BCVA ≥20/70 in 57.0% and final BCVA ≥20/40 in 43.0%. Post vitrectomy complications included; cataract progression (52.9%), high intraocular pressure (35.3%), epiretinal membrane (23.5%), and rhegmatogenous retinal detachment (17.6%). Conclusion: Anatomical and functional outcomes of Eales’ disease with vitreous hemorrhage were relatively good following either conservative treatment or PPV. Each treatment option offered both advantages and disadvantages. The risks and benefits of each treatment option should be discussed with each individual patient to achieve the optimal outcome. Due to being a less invasive procedure, conservative treatment should be initially performed with close monitoring. In the minority of patients, vitrectomy still plays an important role to improve visualization and enable laser photocoagulation, despite potential risk of cataract progression.