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Swetangi D. Bhaleeya, Jane Fishler, Thomas Albini, Janet Davis; Optic coherence tomography findings in Posterior uveitis secondary to Syphilis. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1201.
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© ARVO (1962-2015); The Authors (2016-present)
To analyze optic coherence tomography (OCT) findings in syphilis posterior uveitis
A retrospective chart review was performed of 23 patients with laboratory-confirmed syphilis uveitis. Those with ocular inflammation limited to the anterior segment were excluded. Cases with no OCT at the time of active inflammation were also excluded. Demographic data such as age and gender were recorded. HIV status as well as RPR titers was noted. Clinical exam findings at the time of presentation and at last follow-up visit were recorded. OCT scans were reviewed and interpreted by a single observer (TAA) masked to all other clinical data. Macular thickness was recorded.
Of the 23 laboratory-confirmed cases of syphilis uveitis reviewed, 10 cases (18 eyes) were included. All 10 patients were male with a mean age of 48. Eight of the 10 cases had bilateral involvement. Six of the 10 patients were HIV positive. More than fifty percent of the patients tested positive for both RPR and FTA-ABS, whereas 3 had a non-reactive RPR but reactive FTA-AB. Results of cerebrospinal fluid were documented in 5 of the 10 cases and 3 of the 5 patients had positive VDRL. There were six cases of chorioretinitis, two with neuroretinitis, one with retinal vasculitis, and one with optic neuritis. Visual acuity at presentation ranged from 20/20 to count fingers. OCT scans were reviewed for 18 eyes. Average central retinal thickness at was 298µm (range 167 - 558). Four of 18 eyes had subretinal fluid, two had preretinal precipitates, two had foveal atrophy, two exhibited photoreceptor inner segment/outer segment (IS/OS) junction disruption, and two with RPE nodularity. There was also one case of cystoid macular edema, one showing posterior hyaloid opacities, and one with inner retinal hyperfluorescence.
Multiple OCT findings were observed in posterior segment syphilitic uveitis, including shallow neurosensory detachment, preretinal precipitates, thinning of the umbo, and changes in the RPE and/or IS/OS junction. Shallow neurosensory detachment was the most common finding in this case series. Syphilitic uveitis can often masquerade as other forms of uveitis; the OCT findings suggest multiple pathophysiologies in posterior segment uveitis secondary to syphilis.
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