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J. Fishler, E. Mandelcorn, T. A. Albini, J. L. Davis; A Review of Ocular Syphilis and Its Clinical Characteristics in Bascom Palmer Over a Seven Year Period. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5866.
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To review the prevalence and clinical characteristics of ocular syphilis in Bascom Palmer Eye Institute from 2003 to 2009.
A retrospective review was undertaken to identify patients with ocular syphilis using ICD-9 billing codes as well as serology testing done in Bascom Palmer from 2003 to 2009. Patients were identified as having ocular syphilis if all of the following were present: clinical suspicion, positive serologies, resolution of symptoms after treatment with intramuscular or intravenous penicillin and no other attributable causes to ocular inflammation.
Twenty patients were identified with ocular syphilis from 2003 to 2009. All patients were FTA-ABS positive. 18/20 patients were RPR positive. 16/18 of RPR positive patients (89%) had a titer ≥ 1:64. 6/11 patients (55%) who had lumbar punctures performed had RPR or VDRL positive CSF. 5/6 of these patients were HIV positive. 15/20 patients (75%) were male and 11/20 patients (55%) were HIV positive at the time of the diagnosis. All HIV positive patients had titers ≥ 1:64, with 7/11 patients (60%) having RPR titers ≥ 1:512. Only 5/9 HIV negative patients had RPR titers ≥ 1:64. All patients had intraocular inflammation at the time of the diagnosis ranging from mild to severe. 7/20 had synechiae and 9/20 had keratic precipitates. 17/20 patients had posterior segment involvement at the time of the diagnosis including optic nerve head edema, vascular abnormalities and retinal/subretinal infiltrates. All patients had visual improvement and/or resolution of ocular inflammation after treatment with IM or IV penicillin.
The prevalence of syphilis in the US is rising. However, by our criteria 20 patients with definite ocular syphilis could be identified at our tertiary care center over the preceding 7 years. A majority of these patients were young HIV positive males with posterior segment inflammation. Treatment with IV or IM penicillin is critical in symptom resolution.
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