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Joseba Artaraz, Spanish study for Ocular Syphilis (SOS)-group; SOS: Spanish study for Ocular Syphilis. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3197.
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The primary objective was to describe the clinical features and visual outcomes of patients with syphilitic uveitis in Spain. The secondary objective was to assess differences between these patients and patients with syphilis without uveitis in terms of demographic characteristics, HIV status, viral load and CD4 count and cerebrospinal fluid findings.
Retrospective and comparative case series study. Fourty patients diagnosed with syphilitic uveitis from 7 centers in Spain since year 2000 and 86 randomly selected syphilitic patients without uveitis diagnosed in the same centers during the same period were included. Clinical and laboratory data were collected from the clinical records. Statistics: Mann-Whitney U and Chi 2 tests.
The most frequent anatomic type of uveitis was posterior : 60%. Granulomatous inflammation of the anterior chamber was observed in 3 patients, 7.5%. Several types of posterior segment inflammation were observed: optic neuritis (40%), retinal vasculitis (20%), necrotizing retinopathy (35%), posterior placoid chorioretinitis (10%), serous retinal detachment (5%), neuroretinitis (5%), vitritis (35%), macular edema (7.5%), multifocal choroiditis (2.5%), multifocal chorioretinitis (10%). Mean initial visual acuity (VA) of right and left eyes (RE, LE) was 0.36 and 0.45 respectively. Final VA of RE and LE was 0.67 and 0.72 respectively. Final VA was statistically better in both eyes (RE p=0.018, LE p= 0.048). Mean follow-up: 28.71 months.We did not find differences between patients with syphilis without uveitis and patients with uveitis in terms of age and sex distribution (p= 0.371, p=0.990). We observed more frequently homosexual and HIV+ patients in the group of uveitis (p<0.0001 and p=0.05). HIV patients from both groups did not presented differences in CD4 count and viral load (p=0.473, p=0.349). Patients with uveitis had higher amount of cells in cerebrospinal fluid: 471.22 vs 5,p=0.020. No differences were observed in the concentration of proteins (p=0.606) and frequency of positive serology (p=0.110).
In this relatively large series of spanish patients with syphilitic uveitis, posterior uveitis was the most frequent type of uveitis observed. Optic neuritis, necrotizing retinopathy and vitritis were the most frequent manifestations of posterior segment inflammation. Prognosis was favourable in terms of VA. In the group of patients with syphilitic uveitis, HIV+ and homosexual patients were more frequent. Patients with uveitis presented a greater number of cells in the cerebrospinal fluid than patients without uveitis.
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