Objectives To investigate the clinical characteristics and prognosis of syphilitic uveitis. Methods Clinical charts of 32 syphilitic uveitis patients were retrospectively analyzed. The diagnosis was confirmed by clinical and laboratory tests. There were 32 patients (50 eyes), 18 males and 14 females; the ages were from 21 to 62 years ole, with a mean age of 42 years old. Eighteen patients were bilateral. All patients had complete ocular examinations including visual acuity, intraocular pressure, slit-lamp biomicroscopy, ophthalmoscopy, fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA). Results Inflammatory cells in the anterior chamber and corneal endothelium were present in 42 eyes. Thirty eyes showed congestion and swelling of optic discs. Yellowwhite lesions in the posterior pole were present in 18 eyes. No change in 6 eyes. FFA showed staining or hyperfluorescence of optic disc in 32 eyes, venous leakage in 34 eyes, and cystoid macular edema in 15 eyes．ICGA showed squamous or disseminative hypofluorescence damages in 26 eyes. All patients were treated with penicillin and glucocorticoids, 36 eyes had improved vision and fundus damage had abated. Conclusions Most syphilitic uveitis was panuveitis with retinal vasculitis. The prognosis is good with early diagnosis and timely treatment of this disease．
Objective To evaluate the clinical features and treatment outcomes of ocular posterior segment syphilis. Methods The clinical data of 24 patients with active ocular syphilis were retrospectively reviewed. The diagnosis was made first in eye clinic，and verified by treponema pallidum particle agglutination (TPPA) and rapid plasma reagin (RPR). The patients, 17 males and 7 females, aged from 30 to 63 years with an average of 47.6 years. The duration of symptoms ranged from 3 days to 2 years with an average of 5.8 months (le;1 month, 7 cases; 1-3 month, 5 cases; 3-6 months, 5 cases; ＞6 months, 7 cases). There were 18 bilateral cases and 6 unilateral cases. The result of human immunodeficiency virus (HIV) test was negative for all cases. Twenty-three patients received systemic penicillin therapy and 1 patient was treated with oral erythromycin due to penicillin allergy. Before treatment, the mean visual acuity was 0.17plusmn;0.19，the mean titer of RPR was 1:84。The follow-up period was half a year. Results The major ocular manifestations included bilateral (16 cases) or unilateral (1 case) chorioretinitis, unilateral retinal vasculitis (2 cases), unilateral neuroretinitis (2 cases), and bilateral (2 cases) or unilateral (1 case) optic neuritis. The mean follow-up visual acuity was 0.60plusmn;0.29，the mean follow-up titer of RPR was1:18.8. Some patients had got the diagnosis and prompt treatment at the early stage of the disease and their visual acuity recoveried very well. Conclusions The major manifestion of ocular posterior segment syphilis is chorioretinitis. It is important to consider the possibility of syphilis when patients have inflammation of posterior segment. Prompt serology examination and penicillin treatment are the keys to cure ocular syphilis.
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.
Acquired syphilis uveitis, due to lack of the characteristic features, presents with various types. The most common type is posterior uveitis and panuveitis, including chorioretinitis, retinal vasculitis, optic nerve retinitis. The diagnosis and assessment of response to treatment depends mainly on the serological diagnostic tests, including nontreponemal and treponemal test. Acquired syphilis uveitis often presents with manifestations similar to various types of uveitis, especially to autoimmune uveitis and other infectious uveitis, so differential diagnosis is important. The gold standard treatment for active syphilitic uveitis is penicillin G, or doxycycline if patient is allergy to penicillin. Clinically misdiagnosis and delayed treatment may result in irreversible visual impairment and severe systemic and eye complications. However such timely treatment always has a good prognosis.
ObjectiveTo observe the multimodal imaging features of the eyes with acute syphilitic post-polar squamous chorioretinitis (ASPPC) at different stages of disease.MethodsA retrospective case study. From July 2016 to March 2019, 8 patients (11 eyes) of ASPPC patients diagnosed in the ophthalmological examination of Yunnan Second People's Hospital were included in the study. Among them, there were 7 males (10 eyes) and 1 female (1 eye); the average age was 48.7±8.9 years; the average course of disease was 13.24 ±11.30 months. All patients underwent fundus color photography, infrared photography (IR), FAF, FFA, OCT, OCT angiography (OCTA). According to the stage and characteristics of the disease, the affected eyes were divided into acute phase and absorption phase, with 7 and 4 eyes respectively. We observed the color fundus images of ASPPC, IR, FAF, FFA, OCT, OCTA image characteristics of different disease stages.ResultsIn the acute phase, the posterior pole subretinal yellow-white squamous lesions, neuroepithelial detachment, and yellow-white exudates were observed in fundus color photography; uneven infrared reflections can be seen in the lesion area by IR; the posterior pole was round or scaly with strong autofluorescence in FAF, the range was larger than the fundus color photography; FFA arteriovenous stage lesions showed fuzzy weak fluorescence, the fluorescence gradually increased with time, the late stage showed a round-shaped strong fluorescence, surrounded by a weak fluorescence ring, and the area with thick exudation was covered by fluorescence; the neuroepithelium of the diseased area was detached, the uniform strong reflection signal can be seen in it by OCT. In the absorption phase, fundus color photography showed the yellow-white scaly lesions under the posterior retina absorption, and the pigment was slightly depleted; IR showed the mottled infrared reflection in the lesion area was significantly reduced compared with the acute phase; FAF showed the posterior spot-like strong autofluorescence, including "leopard spot-like changes" 3 eyes; FFA showed mottled fluorescent staining in the lesion, and no fluorescein leakage or accumulation; OCT showed needle-like protrusions in the RPE layer, and the outer membrane and ellipsoid zone were unclear; OCTA showed weakened choroidal capillary blood flow signal, the signal was missing in some areas.ConclusionsIn the acute phase of ASPPC, the posterior pole subretinal shows yellow-white squamous lesions, neuroepithelial detachment, yellow-white exudate, FFA shows late fluorescein leakage in the lesion area; in the absorption period, the fundus shows yellow-white lesions have been absorbed, and FFA shows fluorescence dyed without any leakage. OCT indicates that the RPE, outer membrane and ellipsoid zone are damaged to varying degrees. OCTA indicates that the choroid of the diseased area had weakened blood flow signal.