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      Eales' disease - current concepts in diagnosis and management

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          Abstract

          Eales' disease, first described by the British ophthalmologist Henry Eales in 1880, is characterized by three overlapping stages of venous inflammation (vasculitis), occlusion, and retinal neovascularization. Diagnosis is mostly clinical and requires exclusion of other systemic or ocular conditions that could present with similar retinal features. In recent years, immunological, molecular biological, and biochemical studies have indicated the role of human leukocyte antigen, retinal autoimmunity, Mycobacterium tuberculosis genome, and free radical-mediated damage in the etiopathogenesis of this disease. However, its etiology appears to be multifactorial. The management depends on the stage of the disease and consists of medical treatment with oral corticosteroids in the active inflammatory stage and laser photocoagulation in the advanced retinal ischemia and neovascularization stages.

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          Most cited references34

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          Low content of the natural ocular anti-angiogenic agent pigment epithelium-derived factor (PEDF) in aqueous humor predicts progression of diabetic retinopathy.

          Retinopathy is the most common microvascular complication of diabetes. Our aim was to address the predictive value of pro-angiogenic and anti-angiogenic markers for progression of retinopathy. Aqueous humor was collected at cataract surgery from 32 diabetic patients who had no or very mild retinopathy (ETDRS stage 47B). This subgroup showed lower pigment epithelium-derived factor content when compared to non-progressors and control subjects. Migratory activity in samples of patients from the control group and in diabetic patients without progression was generally inhibitory due to pigment epithelium-derived factor. Inhibition was blocked by neutralizing antibodies to pigment epithelium-derived factor. In diabetic patients initial angiogenic activity was higher in those who later developed retinopathy (vs. controls p=0.00005; vs. no progressors p=0.0003). Both pigment epithelium-derived factor and migratory response predicted progression. Pigment epithelium-derived factor is an important negative regulator of angiogenic activity of aqueous humor. Its content in the aqueous humor of diabetic patients strongly predicts who among them will develop progression of retinopathy.
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            Quantitative polymerase chain reaction for Mycobacterium tuberculosis in so-called Eales' disease.

            To report mycobacterial load in the vitreous of patients labeled as having Eales' disease. Eighty-eight patients were prospectively enrolled into 3 groups: 28 patients with so-called Eales' disease (group A); 30 positive controls with specific uveitis syndromes (group B), and 30 negative controls (group C). The undiluted vitreous humor samples were collected and subjected to real-time PCR assay for MPB64 gene of Mycobacterium tuberculosis (MTB) and load quantified. Sixteen (57.14%) vitreous fluid samples in group A; 1 sample in group B, and none of the samples in group C were positive for MTB genome from the vitreous. The copies of MTB genomes in the positive samples in group A were 1.52 × 10(4) to 1.01 × 10(6). MTB genome was demonstrated in more than 50% of vitreous fluid samples with significant bacillary load, indicating that half of patients with so-called Eales' disease are indeed cases of tubercular vasculitis.
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              Intravitreal triamcinolone acetonide in Eales disease.

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                Author and article information

                Journal
                J Ophthalmic Inflamm Infect
                J Ophthalmic Inflamm Infect
                Journal of Ophthalmic Inflammation and Infection
                Springer
                1869-5760
                2013
                14 January 2013
                : 3
                : 11
                Affiliations
                [1 ]Department of Uveitis and Ocular Pathology, Vision Research Foundation, Sankara Nethralaya, No. 41, College Road, Nungambakkam, Chennai, 600006, India
                [2 ]Little Flower Hospital and Research Centre, P.O. Box No. 23, Angamaly Kochi, Kerala, 683572, India
                [3 ]Biochemistry Department, Vision Research Foundation, Sankara Nethralaya, No. 41, College Road, Nungambakkam, Chennai, 600006, India
                [4 ]Department of Microbiology and Molecular Biology, Vision Research Foundation, Sankara Nethralaya, No. 41, College Road, Nungambakkam, Chennai, 600006, India
                Article
                1869-5760-3-11
                10.1186/1869-5760-3-11
                3605068
                23514227
                9c72046d-3395-4638-b186-cab4c6e0c55d
                Copyright ©2013 Biswas et al.; licensee Springer.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 22 November 2012
                : 27 November 2012
                Categories
                Review

                Ophthalmology & Optometry
                antioxidants,eales' disease,human leukocyte antigen,photocoagulation,polymerase chain reaction,retinal vasculitis,tuberculosis,vitrectomy

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