Title

DIFFERENTIAL DIAGNOSIS OF RETINAL VASCULOPATHY IN A YOUNG PATIENT

Introduction

Eales disease is an idiopathic inflamatory venous occlusion that affects healthy young adults, mostly male, with onset of symptoms between 20 and 30 years. As the ethiopathogenesis of Eales disease still remains an enigma, its clinical course can be caracterized by four overlapping stages. Diagnosis is predominantly clinical and requires exclusion of other systemic and ocular condition. The treatment is symptomatic. The available treatments are corticosteroids, anti-VEGF therapy, photocoagulation with or without cryoablation and vitrectomy.

Methods

Male, 26 years-old, presented to the Emergency Room with a chief complaint of sudden painless decrease of visual acuity in the Left Eye (OS) one week before. He denied ocular trauma and any other ocular symptoms. The past clinical history was unremarkable. The Best Corrected Visual Acuity on the Right Eye (OD) was 20/20 and on the OS was 20/50. No alterations were observed on the Anterior Biomicroscopy of both eyes (OU), and on OD fundus examination ghost vessels and areas of intra-retinal haemorrhages were found. OS fundus examination revealed intra-retinal haemorrhages and areas of vasculitis. The investigation included Fluorescein Angiography (FA) of OU, which revealed areas of low blood perfusion and retinal neovascularization. Infectious diseases’ screening revealed Tuberculin Skin Test as the only positive test. The Hemoglobin Electrophoresis ruled out any Hemoglobin disease. Auto-immune biomarkers were also screened and none were positive. The diagnostic of Eales’ Diasease was made, and Pan Retinal Photocoagulation (PRP) of OU was performed. The patient remained with a BCVA on OD of 20/20 and 20/50 on OS.

Results

Not Apply

Discussion

This case demonstrates the importance of the logic of ocular and systemic propaedeutics in the study of the differential diagnoses of an uncommon disease and how this propaedeutics is important for a good visual outcome and a good control of the underlying pathology.

Keywords

Retinal Vasculipathy; Eales Disease

Area

CLINICAL CASE

Authors

ALLAN GOMES DA SILVA, LEONARDO AMARANTE PEREIRA, BIANCA NICOLELA SUSANNA, GABRIEL SANDOVAL CASTILHO BARBOSA, CRISTINA NERY CARBAJO, BRUNO KNOBEL ULRYCH, LUCIANO RABELLO NETTO CIRILLO, JULIO ZAKI ABUCHAM NETO