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Ahmadreza Moradi, Sherveen Salek, Ebenezer Daniel, Sapna Gangaputra, Trucian A Ostheimer, Bryn Burkholder, Theresa G Leung, Nicholas J Butler, James P Dunn, Jennifer E Thorne; Clinical Features and Incidence Rate of Ocular Complications in Patients with Ocular Syphilis in the Absence of HIV infection.. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5294.
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To describe the incidence rates (IR), treatment, and clinical features of ophthalmic manifestations of ocular syphilis in the absence of human immunodeficiency virus (HIV) infection in a tertiary ophthalmology referral clinic.
Retrospective, consecutive chart review was performed on patients with ocular syphilis in the absence of HIV infection among patients attending the ocular immunology clinics at Johns Hopkins Hospital between 1984 and 2013. Demographic and clinical characteristics were noted at the time of presentation. Outcomes were determined retrospectively. Main outcome measures were the IR of vision impairment (20/50 or worse), loss of visual acuity (20/200 and worse), and development of ocular complications.
15 patients (25 eyes) were included in the study. Follow-up data were available for 13 patients (21 eyes) with a mean follow-up time of 18.9 months (range 0.6-52.9). The incidence rates of visual impairment and visual loss were 0.29 per eye-year (EY) (95% CI: 0.06 -0.86) and 0.07/EY (95% CI: 0.009 - 0.27), respectively. 11 eyes had an ultimate visual acuity of 20/40 or better (52%). The incidence rate of new ocular hypertension (IOP>21mmHg) was 0.20/EY (95% CI: 0.07 -0.43). None of the eyes had epiretinal membrane (ERM) at presentation; however, 6/21 of them developed ERM during the follow-up (IR: 0.21, 95% CI: 0.07 - 0.45). No new retinal detachment, hypotony, choroidal neovascularizaiton, or optic neuropathy was observed during follow-up of the patients.
The re-emergence of syphilis has raised the importance of better characterizing its ocular manifestations. Tertiary syphilis has a broad range of ocular manifestations, the differential for which remains broad and requires proper diagnostic workup. Our data collected over three decades demonstrates the importance of proper treatment in the responsiveness and recovery of visual acuity with intravenous penicillin, and close monitoring in the subsequent months.
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