ArticleThe American journal of case reports2026
Bilateral Eales' Disease Managed With Vitrectomy and Anti-VEGF Therapy: A Case Report.
Article in The American journal of case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND Eales' disease - a rare idiopathic retinal vasculitis typically affecting young adult men - is characterized by periphlebitis, retinal ischemia, and neovascularization. Vitreous hemorrhage and tractional retinal detachment often occur; timely diagnosis and individualized management remain critical. This report describes bilateral Eales' disease with an asymmetrical clinical course and complex treatment strategy incorporating vitrectomy, systemic immunosuppression, and targeted anti-vascular endothelial growth factor (anti-VEGF) therapy. CASE REPORT A 32-year-old White man without systemic illness, infectious exposure, or substance use exhibited left-eye vitreous hemorrhage. Best-corrected visual acuity (BCVA) was hand motion (≈2.3 logarithm of the minimum angle of resolution [logMAR]) in the left eye and 5/6 (≈0.08 logMAR) in the right eye. Ultrasonography and fluorescein angiography demonstrated vitreoretinal traction and peripheral retinal ischemia. After exclusion of infectious etiologies, the diagnosis was bilateral Eales' disease. We performed left-eye vitrectomy with cataract extraction, panretinal photocoagulation (PRP), and systemic immunosuppression with azathioprine, followed by methotrexate. One year later, right-eye disease progression required intravenous methylprednisolone, PRP, and preoperative intravitreal faricimab, followed by vitrectomy. Faricimab-mediated inhibition of vascular endothelial growth factor A (VEGF-A) and angiopoietin-2 (Ang-2) enhanced vascular stabilization. At final follow-up - 18 months after left-eye vitrectomy and 12 months after right-eye vitrectomy - BCVA was 0.00 logMAR (5/5) in both eyes. CONCLUSIONS Early vitrectomy with systemic immunosuppression and adjunctive anti-VEGF therapy may achieve excellent long-term visual outcomes in bilateral Eales' disease. Faricimab application highlights the utility of dual VEGF-A/Ang-2 pathway inhibition in surgical planning. Future studies will clarify anti-VEGF agent efficacies in this rare retinal vasculitis.
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