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.

This study analyses the efficacy and safety of combination of methotrexate and mycophenolate mofetil with treatment-resistant uveitis and scleritis. Method: Retrospective Chart Review. The study included five patients with uveitis and one with scleritis who received combination of antimetabolites. The median age of these patients was 19.5 years, and all of them had bilateral involvement. Two patients had Juvenile Idiopathic Arthritis while one patient each had Behçet's disease, Eales disease, undifferentiated anterior scleritis and pars planitis. The median duration of immunosuppressive and/or corticosteroid treatment before switching to combined therapy was 217 (192-1325) days. Remission of uveitis was achieved in all patients. The median duration of follow-up in these patients was 338.5 (209-901) days. At the end of the follow-up, topical steroids were withdrawn in three eyes, and oral corticosteroids were tapered off completely. All except one patient tolerated the combined treatment. The combination of oral methotrexate and mycophenolate mofetil can be a useful alternative in patients resistant to conventional immunosuppression.

This systematic review evaluates clinical trials and quasi-experimental studies reporting diagnostic criteria, disease activity scoring systems (including Disease Activity Index (DAI), Total Inflammatory Activity Index (TIAI), and Total Adjusted Disease Activity Index (TADAI), and others), and therapeutic strategies used in noninfectious retinal vasculitis (RV), aiming to consolidate current evidence on treatment response and effectiveness measures. Of 5533 articles screened (PROSPERO: CRD42023489232), 15 studies met the inclusion criteria. Most were conducted in Asia (73.3 %) and focused on Behçet disease (60 %) or Eales disease (27 %). RV was diagnosed clinically in all studies, while half incorporated fluorescein angiography to confirm vascular inflammation through leakage, staining, or occlusion; however, definitions of RV were highly variable, often inferred rather than explicitly stated, and lacked standardization. This diagnostic inconsistency, combined with limited imaging data, undermines comparability across studies. Disease activity was assessed using outdated composite indices such as the DAI, TIAI, and TADAI, which lack external validation and fail to capture key clinical features such as macular ischemia or capillary non-perfusion. Best corrected visual acuity, although frequently reported, was confounded by unrelated factors such as cataracts or macular scarring. Therapeutic strategies included systemic corticosteroids, immunosuppressants (e.g., methotrexate, azathioprine), and biologics (e.g., infliximab, interferon-alpha). Treatment selection was heterogeneous, and several regimens-such as cyclophosphamide-azathioprine combinations-do not align with current standards of care. Due to variability in study design and outcome reporting, no pooled effect estimates, or statistical comparisons were conducted. Treatment outcomes were synthesized descriptively based on individual study findings. Current evidence in RV clinical trials is outdated and lacks diagnostic and therapeutic standardization. There is a particular need for RV-specific definitions, validated disease activity and response indices, and contemporary therapeutic trials to guide clinical management and improve outcome comparability.

This systematic review and meta-analysis investigate global diagnostic approaches for retinal vasculitis (RV), with a focus on infectious and non-infectious causes. As in our prior report, systematic searches were conducted in 5 databases and registered in PROSPERO (CRD42023489232). Studies included articles on at least 10 patients with RV without publication date or language restrictions. RV was categorized as secondary RV if they were associated with systemic disease, syndromic if they were associated with a syndromic ocular disease without systemic disease, idiopathic RV without association to systemic or syndromic ocular diseases. This report includes 84 studies analyzing 3480 patients with RV. Among infectious causes, tuberculosis tests were frequently reported, with TST/IGRA positivity observed in 31.4 % (95 % CI: 17.2-50.2 %) of de novo RV cases, increasing to 64.7 % (95 % CI: 47.8-78.9 %) in confirmed tubercular RV and 65.7 % (95 % CI: 39.0-85.1 %) in Eales disease. Chest radiograph abnormalities were present in 21.8 % (95 % CI: 12.9-33.8 %) of tubercular RV cases. Non-infectious causes showed notable regional variability. HLA-B51 positivity was 1 % (95 % CI: 0.03-3.1 %) in de novo RV, but rose to 61.4 % (95 % CI: 23.1-89.4 %) in Behçet's RV. Sarcoidosis RV revealed noncaseating granulomas in 80.5 % (95 % CI: 9.7-99.4 %), with angiotensin-converting enzyme elevation in 4.6 % (95 % CI: 2.3-9.1 %). This study highlights significant geographic variability in RV etiologies. Tuberculosis remains a key infectious cause, while non-infectious causes vary regionally. Region-specific diagnostics and Bayesian testing protocols are critical to improving diagnostic accuracy and patient outcomes.