A 45-year-old woman with Eales disease presents with recurrent vitreous hemorrhage. She has undergone two prior episodes of vitreous hemorrhage with spontaneous clearing. Fundus fluorescein angiography shows peripheral capillary non-perfusion and neovascularization elsewhere (NVE) at the junction of perfused and non-perfused retina. Which is the definitive treatment to prevent recurrence?

• A Intravitreal anti-VEGF injection
• B Sector photocoagulation to the area of neovascularization
• C Pars plana vitrectomy
• D Panretinal photocoagulation to the peripheral ischemic retina ✓

Explanation

Eales disease is characterized by peripheral retinal vasculitis, capillary non-perfusion, and neovascularization. Sector photocoagulation alone to neovascular fronds is insufficient as the underlying ischemia persists. Panretinal (or targeted peripheral) photocoagulation reduces the ischemic drive and causes regression of neovascularization. Vitrectomy is reserved for non-clearing vitreous hemorrhage. Anti-VEGF is adjunctive, not definitive.

Reference: Ryan's Retina, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.