Multimodal fundus imaging in patients of syphilitic posterior uveitis at different stages_Chinese Journal of Ocular Fundus Diseases

Authors：

YangWeidan , YuSuqin , WangHong , XieLiping ,  GongYuanyuan

Department of Ophthalmology, Shanghai First People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200080, China (Yang Weidan is now in Department of Ophthalmology, Tongzhou People Hospital, Nantong 226300, China);

Corresponding author：

GongYuanyuan, Email: gyydr@126.com

Keywords：

Syphilis/complications; Uveitis, posterior/diagnosis; Tomography, optical coherence; Fluorescein angiography

DOI：

10.3760/cma.j.issn.1005-1015.2017.01.009

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To observe the fundus imaging characteristics of different stages of syphilitic posterior uveitis. Methods Retrospective cases series. Forty-six eyes of 32 patients with syphilitic posterior uveitis were included. There were 14 patients (16 eyes) and 18 patients (30 eyes) were assigned to acute stage group (with the course ＜2 months) and chronic stage group (with the course ≥2 months) respectively. All eyes received the examination of indirect ophthalmoscopy, color fundus photography, fundus fluorescein angiography (FFA) and optical coherence tomography (OCT). All patients received regular anti-syphilitic treatment. Color fundus photography and OCT were followed after treatment. The fundus imaging characteristics of different stages of syphilitic posterior uveitis were observed. Results Indirect ophthalmoscopy and fundus color photography showed that in the acute stage group, there were 3/16 eyes with optic disc edema; 4/16 eyes with a yellowish, placoid lesion involving the macular. There were only some pigment alterations on the fundus after treatment. In the chronic stage group, there were 4/30 eyes with optic disc hyperemia, 3/30 eyes with cystoid macular edema. After treatment, the optic hyperemia vanished gradually, but there were still some pigment alterations. The FFA images of two groups showed various vascular leakages. In the chronic stage group, patients also showed hyper-fluorescence with cystoid macular edema. The patients with course 2 – 3 years have more transmitted fluorescence on FFA. OCT showed that all eyes in the acute stage group had lost the ellipsoid zone, with irregular granular reflectivity of the retinal pigment epithelium (RPE) layer, 6 eyes with subretinal fluid in the macular. After treatment, the ellipsoid zone and RPE layer structure recovered gradually. In the chronic stage group, all eyes showed widespread loss of the ellipsoid zone, pigment migration and (or) cystoid macular edema. After treatment, the ellipsoid zone showed partial recovery. The outer ellipsoid zone was still discontinuous in patients with long duration. Conclusions Syphilitic posterior uveitis patients generally had normal fundus, but some cases had a yellowish, placoid lesion involving the macular. FFA showed various vascular leakages, and the chronic stage group showed more transmitted fluorescence. The major OCT change was loss of the ellipsoid zone or with subretinal fluid. After treatment, fundus showed no abnormal manifestations except some pigment alterations; the ellipsoid zone structure recovered gradually in acute stage eyes, partially recovered in chronic stage eyes.

Citation： YangWeidan, YuSuqin, WangHong, XieLiping, GongYuanyuan. Multimodal fundus imaging in patients of syphilitic posterior uveitis at different stages. Chinese Journal of Ocular Fundus Diseases, 2017, 33(1): 31-35. doi: 10.3760/cma.j.issn.1005-1015.2017.01.009 Copy

1.	Kiss S, Damico FM, Young LH. Ocular manifestations and treatment of syphilis[J].Semin Ophthalmol, 2005, 20: 161-167. DOI: 10.1080/08820530500232092.
2.	张美芬.警惕梅毒性葡萄膜炎[J].中华眼科杂志, 2008, 44(10): 867-869. DOI: 10.3321/j.issn: 0412-4081.2008.10.002.Zhang MF. To pay attention to syphilitic uveitis[J]. Chin J Ophthalmol, 2008, 44(10): 867-869. DOI: 10.3321/j.issn: 0412-4081.2008.10.002.
3.	顾莉莉, 吴栋, 王琦, 等.梅毒性后葡萄膜炎眼底表现及眼底血管造影特征[J].中华眼底病杂志, 2010, 26(5): 465-467. DOI: 10.3760/cma.j.issn.1005-1015.2010.05.17.Gu LL, Wu D, Wang Q. Clinical characteristics and fundus fluorescein angiography in syphilitic posterior uveitis[J].Chin J Ocul Fundus Dis, 2010, 26(5): 465-467. DOI: 10.3760/cma.j.issn.1005-1015.2010.05.17.
4.	龙永华, 王卫竣, 宫媛媛, 等.梅毒性后葡萄膜炎的眼底自发荧光与眼底血管荧光造影特征[J].中华实验眼科杂志, 2013, 31(7): 621-624. DOI: 10.3760/cma.j.issn.2095-0160.2013.07.002.Long YH, Wang WJ, Gong YY, et al. Characteristics of fundus autofluorescence and fundus fluorescein angiography in syphilitic posterior uveitis[J].Chin J Exp Ophthalmol, 2013, 31(7): 621-624. DOI: 10.3760/cma.j.issn.2095-0160.2013.07.002.
5.	杨培增. 梅毒及其所致的葡萄膜炎[M]//杨培增. 临床葡萄膜炎. 北京: 人民卫生出版社, 2004: 656-661. Yang PZ. Syphilis and syphilitic uveitis[M]//Yang PZ. Clinical uveitis. Beijing: The Medical House, 2004: 656-661.
6.	Workowski KA, Berman S. Centers for disease control and prevention sexually transmitted disease treatment guidelines[J]. Clin Infect Dis, 2010, 59(1): 67-68. DOI: 10.1093/cid/cir694.
7.	Gass JD, Braunstein RA, Chenoweth RG. Acute syphilitic posterior placoid chorioretinitis[J]. Ophthalmology, 1990, 97(10): 1288-1297. DOI: 10.1016/S0161-6420(90)32418-1.
8.	Ji YS, Yang JM, Park SW. Early resolved acute syphilitic posterior placoid chorioretinitis[J]. Optom Vis Sci, 2015, 92(4 Suppl 1): S55-58. DOI: 10.1097/OPX.0000000000000531.
9.	Eandi CM, Neri P, Adelman RA, et al. Acute syphilitic posterior placoid chorioretinitis: report of a case series and comprehensive review of the literature[J]. Retina, 2012, 32(9): 1915-1941. DOI: 10.1097/IAE.0b013e31825f3851.
10.	Pilli S, Lim P, Zawadzki RJ, et al. Fourier-domain optical coherence tomography of eyes with idiopathic epiretinal membrane: correlation between macular morphology and visual function[J]. Eye, 2011, 25(6): 775-783. DOI: 10.1038/eye.2011.55.
11.	Pichi F, Ciardella AP, Cunningham ET, et al. Spectral domain optical coherence tomography findings in patients with acute syphilitic posterior placoid chorioretinopathy[J]. Retina, 2014, 34(2): 373-384. DOI: 10.1097/IAE.0b013e3182993f11.
12.	Armstrong BK, Pitcher J, Shah R, et al. The evolution of untreated acute syphilitic posterior placoid chorioretinitis captured by multimodal retinal imaging[J]. Ophthalmic Surg Lasers Imaging Retina, 2014, 45(6): 606-609. DOI: 10.3928/23258160-20141008-02.
13.	Aranda S, Amer R. Sequential spontaneous resolution of acute syphilitic posterior placoid chorioretinitis[J]. Eur Ophthalmol, 2015, 25(3): 263-265. DOI: 10.5301/ejo.5000530.
14.	Landa G, Su E, Garcia PM, et al. Inner segment-outer segment junctional layer integrity and corresponding retinal sensitivity in dry and wet forms of age-related macular degeneration[J]. Retina, 2011, 3l(1): 364-370. DOI: 10.1097/IAE.0b013e3181e91132.

1. Kiss S, Damico FM, Young LH. Ocular manifestations and treatment of syphilis[J].Semin Ophthalmol, 2005, 20: 161-167. DOI: 10.1080/08820530500232092.
2. 张美芬.警惕梅毒性葡萄膜炎[J].中华眼科杂志, 2008, 44(10): 867-869. DOI: 10.3321/j.issn: 0412-4081.2008.10.002.Zhang MF. To pay attention to syphilitic uveitis[J]. Chin J Ophthalmol, 2008, 44(10): 867-869. DOI: 10.3321/j.issn: 0412-4081.2008.10.002.
3. 顾莉莉, 吴栋, 王琦, 等.梅毒性后葡萄膜炎眼底表现及眼底血管造影特征[J].中华眼底病杂志, 2010, 26(5): 465-467. DOI: 10.3760/cma.j.issn.1005-1015.2010.05.17.Gu LL, Wu D, Wang Q. Clinical characteristics and fundus fluorescein angiography in syphilitic posterior uveitis[J].Chin J Ocul Fundus Dis, 2010, 26(5): 465-467. DOI: 10.3760/cma.j.issn.1005-1015.2010.05.17.
4. 龙永华, 王卫竣, 宫媛媛, 等.梅毒性后葡萄膜炎的眼底自发荧光与眼底血管荧光造影特征[J].中华实验眼科杂志, 2013, 31(7): 621-624. DOI: 10.3760/cma.j.issn.2095-0160.2013.07.002.Long YH, Wang WJ, Gong YY, et al. Characteristics of fundus autofluorescence and fundus fluorescein angiography in syphilitic posterior uveitis[J].Chin J Exp Ophthalmol, 2013, 31(7): 621-624. DOI: 10.3760/cma.j.issn.2095-0160.2013.07.002.
5. 杨培增. 梅毒及其所致的葡萄膜炎[M]//杨培增. 临床葡萄膜炎. 北京: 人民卫生出版社, 2004: 656-661. Yang PZ. Syphilis and syphilitic uveitis[M]//Yang PZ. Clinical uveitis. Beijing: The Medical House, 2004: 656-661.
6. Workowski KA, Berman S. Centers for disease control and prevention sexually transmitted disease treatment guidelines[J]. Clin Infect Dis, 2010, 59(1): 67-68. DOI: 10.1093/cid/cir694.
7. Gass JD, Braunstein RA, Chenoweth RG. Acute syphilitic posterior placoid chorioretinitis[J]. Ophthalmology, 1990, 97(10): 1288-1297. DOI: 10.1016/S0161-6420(90)32418-1.
8. Ji YS, Yang JM, Park SW. Early resolved acute syphilitic posterior placoid chorioretinitis[J]. Optom Vis Sci, 2015, 92(4 Suppl 1): S55-58. DOI: 10.1097/OPX.0000000000000531.
9. Eandi CM, Neri P, Adelman RA, et al. Acute syphilitic posterior placoid chorioretinitis: report of a case series and comprehensive review of the literature[J]. Retina, 2012, 32(9): 1915-1941. DOI: 10.1097/IAE.0b013e31825f3851.
10. Pilli S, Lim P, Zawadzki RJ, et al. Fourier-domain optical coherence tomography of eyes with idiopathic epiretinal membrane: correlation between macular morphology and visual function[J]. Eye, 2011, 25(6): 775-783. DOI: 10.1038/eye.2011.55.
11. Pichi F, Ciardella AP, Cunningham ET, et al. Spectral domain optical coherence tomography findings in patients with acute syphilitic posterior placoid chorioretinopathy[J]. Retina, 2014, 34(2): 373-384. DOI: 10.1097/IAE.0b013e3182993f11.
12. Armstrong BK, Pitcher J, Shah R, et al. The evolution of untreated acute syphilitic posterior placoid chorioretinitis captured by multimodal retinal imaging[J]. Ophthalmic Surg Lasers Imaging Retina, 2014, 45(6): 606-609. DOI: 10.3928/23258160-20141008-02.
13. Aranda S, Amer R. Sequential spontaneous resolution of acute syphilitic posterior placoid chorioretinitis[J]. Eur Ophthalmol, 2015, 25(3): 263-265. DOI: 10.5301/ejo.5000530.
14. Landa G, Su E, Garcia PM, et al. Inner segment-outer segment junctional layer integrity and corresponding retinal sensitivity in dry and wet forms of age-related macular degeneration[J]. Retina, 2011, 3l(1): 364-370. DOI: 10.1097/IAE.0b013e3181e91132.

Chinese Journal of Ocular Fundus Diseases

Multimodal fundus imaging in patients of syphilitic posterior uveitis at different stages

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content