April 2014
Volume 55, Issue 13
Free
ARVO Annual Meeting Abstract  |   April 2014
Multidisciplinary imaging of acute syphilitic posterior placoid chorioretinitis: penicillin-treated cases versus penicillin-untreated cases
Author Affiliations & Notes
  • Yujeong Kim
    Hanyang Medical Center, Seoul, Republic of Korea
  • Yong Un Shin
    Hanyang Medical Center, Seoul, Republic of Korea
  • Byung Ro Lee
    Hanyang Medical Center, Seoul, Republic of Korea
  • Heeyoon Cho
    Hanyang Medical Center, Seoul, Republic of Korea
  • Han Woong Lim
    Hanyang Medical Center, Seoul, Republic of Korea
  • Footnotes
    Commercial Relationships Yujeong Kim, None; Yong Un Shin, None; Byung Ro Lee, Nidek (C); Heeyoon Cho, None; Han Woong Lim, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science April 2014, Vol.55, 280. doi:
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      Yujeong Kim, Yong Un Shin, Byung Ro Lee, Heeyoon Cho, Han Woong Lim; Multidisciplinary imaging of acute syphilitic posterior placoid chorioretinitis: penicillin-treated cases versus penicillin-untreated cases. Invest. Ophthalmol. Vis. Sci. 2014;55(13):280.

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Abstract
 
Purpose
 

To describe ophthalmic findings of acute syphilitic posterior placoid chorioretinitis (ASPPC) using the multidisciplinary imaging and compare the image findings between penicillin-treated cases and penicillin-untreated cases

 
Methods
 

: All four patients were diagnosed as ASPPC by using multidisciplinary imaging techniques such as fluorescein angiography (FA), indocyanine green angiography (IA), spectral-domain optical coherence tomography (SD-OCT) and fundus autofluorescence (FAF). At initial visit, all patients showed similar imaging findings. FA revealed irregular late-staining hyperfluorescence of the placoid lesion and diffuse staining of the optic disc and retinal vessels. A revealed early multiple scattered hypofluorescent spots in the lesion and a well-demarcated area of hypofluorescence corresponding to the placoid lesion in late phase. SD-OCT revealed an ill-defined photoreceptor inner/outer segment(IS/OS) junction and absent external limiting membrane(ELM), thickening and granular hyperreflectivity of the retinal pigment epithelium(RPE). FAF images showed central hyperautofluorescence corresponding to the area of the placoid lesion.

 
Results
 

Two patients were treated with intravenous penicillin G and oral prednisolone immediately after the diagnosis, while other two patients were treated with only oral prednisolone due to late diagnosis and follow-up loss. Penicillin-treated cases showed prompt visual recovery and normalization of all imaging findings, while penicillin-untreated cases showed partial visual recovery and abnormal image findings were still remained.

 
Conclusions
 

Our multimodal imaging findings are similar to multiple evanescent white dot syndrome (MEWDS) involving outer retina mainly, which may provide clues for understanding of the pathogenesis of ASPPC. Also we identified that ASPPC should be treated with intravenous penicillin to achieve complete imaging restoration.

     
Keywords: 550 imaging/image analysis: clinical  
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