Bevacizumab May Have a Role in Treating Eales Disease
Eales disease (ED) is a common, idiopathic, inflammatory retinal vasculitis that particularly affects young adults. Current treatments available for ED include corticosteroids, laser photocoagulation, retinal cryotherapy, and surgery, but a recent study found that using intravitreal bevacizumab injections may produce better outcomes and reduce the need for surgery.
Eales disease (ED) is a common, idiopathic, inflammatory retinal vasculitis that particularly affects young adults. The pathogenesis of ED is poorly understood, but some studies have attributed the disease to a response to Mycobacterium Tuberculosis antigens. The disease involves stages of retinal vasculitis, nonperfusion, neovascularization, vitreous hemorrhage (VH) and tractional retinal detachment (TRD).
Current treatments available for ED include corticosteroids, laser photocoagulation, retinal cryotherapy, and surgery, but a recent study, published in the Pakistan Journal of Medical Sciences, found that using intravitreal bevacizumab injections to treat ED may produce better outcomes and reduce the need for surgery.
The paper reports on a trial carried out at a single center from May 2015 to December 2016 in 26 patients—and 52 eyes—diagnosed with ED. Patients were randomized to receive either intravitreal bevacizumab injections or standard treatment with steroids and photocoagulation.
In the group that received bevacizumab, 9 eyes (24.6%) progressed to stage III or stage IV disease, while in the standard treatment group, 18 eyes (69.2%) progressed in disease severity. Six eyes in the bevacizumab group and 16 in the standard treatment group required surgery.
The groups showed comparable regression of vasculitis, but regression of neovascularization was observed more in the bevacizumab group (16 eyes) than the standard treatment group (6 eyes).
The difference in both groups in terms of final disease stage at 12 weeks was not statically significant (P = .066), though the number of eyes in stage I was 15 (58%) in the bevacizumab group versus 6 (23%) in the standard treatment group. “This shows considerably more number of eyes showing regression of ED,” write the authors.
The authors conclude that giving intravitreal bevacizumab injections monthly in patients with stage I or stage II ED results in more regression in vascularization and less need for surgery versus standard therapy, and it should be considered as an adjunct therapy to avoid progression of the disease.
Reference
Mehboob MA, Tahir M, Batool H. Role of intravitreal bevacizumab in management of Eale’s disease. Pak J Med Sci. 2018;34(2):333-337. doi: 10.12669/pjms.342.14483.
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