Sir,

Eales' disease is an idiopathic inflammatory obliterative vasculopathy.1 We describe a case of premacular subhyaloid haemorrhage in Eales' disease managed with Nd:YAG laser posterior hyaloidotomy. We are unaware of such finding in world literature.

Case report

An 18-year-old male patient presented with sudden loss of vision in his left eye. The best corrected visual acuity (BCVA) was 20 of 20 OD and 20 of 800 OS. Slit lamp biomicroscopy revealed normal anterior segment examination bilaterally. The intraocular pressure was 12 mm Hg bilaterally. Fundus examination of the left eye showed premacular subhyaloid haemorrhage, with associated vascular sheathing and superficial haemorrhages along the superotemporal arcade. Fluorescein angiography demonstrated leakage of dye along the areas of vascular sheathing. The right eye fundus was normal with no evidence of leakage of dye or peripheral nonperfusion. Systemic examination was normal.

Laboratory investigations showed haemoglobin of 12 g/100 ml, leukocyte count of 4600/mm3, platelet counts of 230 000/mm3, and ESR of 8 mm. VDRL for syphilis and ELISA for HIV were negative. Chest X-ray was normal.

The patient was started on oral prednisolone 1 mg/kg. Subsequently, Nd:YAG laser posterior hyaloidotomy was also performed far from the fovea, enabling diffusion of the premacular haemorrhage into vitreous cavity. The laser power required was 2 mJ and single bursts were emitted. Fundus showed clearing of premacular haemorrhage and evidence of resolving vasculitis in the left eye after 2 weeks (Figure 1). The BCVA improved to 20 of 32 OS.

Figure 1
figure 1

Fundus photographs showing drainage of premacular subhyaloid haemorrhage into vitreous gel following Nd:YAG laser posterior hyaloidotomy. Active vasculitis can be seen along the superotemporal arcade (top left photograph). Post-treatment fundus photograph (bottom right) showing complete resolution of premacular haemorrhage and resolving vasculitis.

Full size image

Comment

Eales' disease characterized by perivascular sheathing, peripheral retinal nonperfusion, and neovascularization, predominantly affects young males.1, 2 Bilateral involvement is present in 80–90% of patients.1 In this case, other conditions such as sarcoidosis, tuberculosis, syphilis, systemic lupus erythematosus, and primary HIV infection, which could be associated with a similar clinical picture were ruled out.

Macular involvement in the form of cystoids macular oedema and macular pucker has been reported in Eales' disease;3 however, premacular subhyaloid haemorrhage was present in this patient during the active inflammatory stage. Premacular haemorrhage produces profound visual loss, which may be prolonged and cause permanent macular changes. Nd:YAG laser hyaloidotomy has been described as an effective procedure for management of premacular haemorrhages.4, 5 The present case also had immediate clearing of the premacular haemorrhage and early recovery of vision after Nd:YAG laser hyaloidotomy (Figure 1). No retinal or choroidal damage was observed.

To conclude, premacular subhyaloid haemorrhage can be present in Eales' disease, which can be managed effectively with Nd:YAG laser posterior hyaloidotomy.