A 58-year-old Caucasian male with known medical history of dyslipidemia, diabetes mellitus type 2 for 15 years, and ischemic stroke 15 years before presented to the emergency room with complaints of floaters in his left eye over the previous 6 months (Table 1). At presentation, BCVA was 8/10 OD and 5/10 OS. Anterior segment evaluation was unremarkable. Fundoscopy revealed peripheral retinal hemorrhages in both eyes and irregular macular reflex, inferior vitreous hemorrhage, vascular remodeling, and neovascularization in OS (Table 1). Fluorescein angiography showed retinal venous vasculitis with peripheral ischemia and neovascularization in both eyes, with no suggestive appearance of diabetic retinopathy (Figure 4). Patient also performed SD-OCT which revealed epiretinal membrane (ERM) with CME in the OS (Table 1).
Detailed clinical history and thorough systemic examination including serologic analysis, hemogram, inflammatory markers, protein, and hemoglobin electrophoresis were unremarkable. X-ray and CT scan of the thorax evidenced pulmonary parenchyma with apical reticular pattern and residual fibrotic and retracted changes (Table 1). Once other causes of vasculitis and infections have been ruled out and tuberculin skin sensitive test (41 mm) and IGRA (2.77) were positive, Eales' disease was considered.
Patient started a complete quadruple antituberculosis treatment associated with oral corticoid therapy (prednisolone 1 mg/Kg/day) with progressive withdrawal. Scatter laser photocoagulation and three anti-VEGF vitreous injections were also performed in both eyes (Table 1). Although poor patient's compliance, clinical improvement with complete regression of vasculitis and neovascularization was achieved.
Almost 4 years after diagnosis, patient remains clinically stable and had significant visual acuity recovery (BCVA was 10/10 OD and 8/10 OS), maintaining close follow-up and no need for treatment.