New Classification System-based Visual Outcome And Associated Experimental Study In Eales Disease

Purpose: To develop and standardize a universally acceptable new staging system of Eales disease. A retrospective study was undertaken to evaluate the visual outcome in Eales disease, based on a new classification system, for the first time. To investigate the significance of anti-PR3, anti-MPO antibody and ANCA in patients with Eales disease. To study the relationships between the positive rate of PR3,MP0 and the new staging system of Eales disease.Methods: A new staging system was established and standardized based on standard terminology and features. Eales disease consisted of 4 stages. Stage 1 is periphlebitis of small and large caliber vessels with superficial retinal haemorrhages. Stage 2 is capillary non perfusion and neovascularization elsewhere / of the disc. Stage 3 is classified as fibrovascular proliferation and vitreous haemorrhage. Stage 4 is traction/combined rhegmatogenous retinal detachment, macular epiretinal membranes, neovascular glaucoma, complicated cataract. Sixty-two consecutive cases of Eales disease were included. All the eyes were staged according to the new classification: Stage 1 is periphlebitis of small and large caliber vessels with superficial retinal haemorrhages. Stage 2 is capillary non perfusion and neovascularization elsewhere / of the disc. Stage 3 is classified as fibrovascular proliferation and vitreous haemorrhage. Stage 4 is traction/combined rhegmatogenous retinal detachment, macular epiretinal membranes, neovascular glaucoma, complicated cataract. All the cases were managed by medical therapy, photocoagulation and/or vitreoretinal surgery. Visual acuity was converted into decimal scale, denoting 20/20=1 and 20/800=0.01. Paired t-test / Wilcoxon signed-rank tests were used for statistical analysis. Register every stage of every serum of Eales disease. Anti-PR3 and anti-MPO antibody were determined by ELISA and ANCA was determined by indirect immunofluorescence (IIF) in 35 patients with Eales disease and 20 patients of control group. Results: The new staging system was consistent, simple and easy to recall. The new staging system also defined the severity of the disease. Vitreous haemorrhage was found to be the commonest presenting feature (34.1%). Vitreous hemorrhage was the commonest presenting feature (49.32%). Statistically significant improvement in visual acuities was observed in most of all the stages of the disease. There was significant difference(P<0.01) in 35 cases of Eales disease as compared with control group. The positive rate of antiPR3 antibody and cANCA was 54.3% in 35 patients with Eales disease. The positive rate of anti-MPO antibody and pANCA was 22.9% and 31.4%. Based on the new staging system, the positive rate of antiPR3 antibody are 50%, 60%, 66.7% 16.7% respectively.Conclusions: The new staging system is useful in classifying and assessing the severity of disease. Management strategy can also be defined according to the stage of the disease. It is designed to promote the use of standard assessment with applications to clinical management and research. Significant improvement in visual acuities was observed in the majority of stages of Eales disease following treatment. This study adds further to the little available evidences of treatment effects in literature and may have effect on patient care and health policy in Eales disease. Based on the new staging system, among cases of eales disease, the positive rate of anti-PR3 antibody and cANCA,the positive rate of anti-MPO antibody and pANCA were linked with linked with the new staging system. From the standpoint of clinical diagnosis,to evaluate MPO and PR3 simultaneously is necessary. As sensitive markers of Eales disease ,anti-PR3 and anti-MPO antibody may be useful for diagnosis and early treatment. Based on the new staging system, among cases of eales disease, the positive rate of anti-PR3 antibody and cANCA, the positive rate of anti-MPO antibody and pANCA were accord with the new staging system. From the standpoint of clinical diagnosis, to determinate MPO and PR3 simultaneously is necessary.