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Rashmi G. Mathew, Beng Goh, Mark C. Westcott; British Ocular Syphilis Study: 2-year National Surveillance Study: Demographic Data, Visual Outcomes And HIV Presentation Patterns. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3196.
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To ascertain the demographics, characteristics and visual outcome of patients presenting with ocular Syphilis in the United Kingdom and to characterise the clinical presentation patterns in those patients who are HIV positive.
A prospective United Kingdom study, whereby cases of ocular syphilis were reported through the national reporting system (British Ocular Surveillance Unit) over a 2-year period, from May 2009. Case definition was any adult who presented with intraocular inflammation and positive syphilis serology.
41 new cases (63 eyes) of ocular syphilis were reported over a 2-year period.The mean age was 50, with a wide range (21-75 years). The majority were male (90%). 90% were white British or European and 10% were of African or Caribbean ethnicity. 55% of patients had bilateral involvement: of those with unilateral involvement, the left eye was 3 times more commonly affected than the right eye (P<0.07 value). The mean presenting visual acuity was 0.52 logMAR (20/60 Snellen). 52% had visual acuities worse than 0.3 logMAR (20/40 Snellen) at initial presentation. Eyes with uniocular involvement had a greater proportion of retinitis and macular oedema, compared to those with bilateral disease (p = 0.05, Chi square). This significance persisted for macular oedema only, after correcting for inter-eye correlation. 32% of patients were HIV positive. This subgroup were more likely to present with bilateral disease (p=0.05) and have choroiditis (p<0.01). At final follow-up, 92% had visions better than 0.3 logMAR (20/40 Snellen) after antibiotic therapy. HIV status did not influence the final visual outcome.
This study is the largest prospective series of ocular syphilis in the post-penicillin era. In uniocular disease, macular oedema is the commonest diagnosis and there is a tendency for left eyes to be more frequently affected. HIV positive patients tend to present with bilateral disease and choroiditis. This study confirms good visual outcomes for treated ocular syphilis, irrespective of HIV status.
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