Bilateral Eales' Disease Managed With Vitrectomy and Anti-VEGF Therapy: A Case Report

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.