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P Mora, FX Borruat, Y Guex-Crosier; Ocular Syphilis: Indocyanine Green Angiography (ICG) Specific Aspects . Invest. Ophthalmol. Vis. Sci. 2002;43(13):2247.
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Purpose: Ophthalmic manifestations of syphilis are numerous and protean. The ocular involvement may result in a granulomatous anterior uveitis, parsplanitis with cystoid macular oedema (CME), retinochoroiditis, retinal vasculitis and/or optic neuritis. Deep choroidal granuloma have also been described, but they are not easily detectable by funduscopy or fluorescein angiography. The aim of this study is to assess some specific indocyanine green angiography (ICG) findings of tertiary syphilis posterior uveitis in the series under consideration. Method: From May 1996 to November 2001 nine patients (5 males and 4 females, mean age ± SD: 51±9 years) presenting evidences of ocular inflammation and a serological pattern compatible with tertiary syphilis (positive TPHA test and negative VDRL test), were examined at J. Gonin Eye Hospital of Lausanne (Switzerland). Patients were all investigated by ICG angiography according to a standard timing protocol consisting of an early (2-3 minutes), middle (8-12 minutes) and late phase (over 40 minutes) of image capture. Results: Bilateral ocular involvement was evident in 7/9 patients. Four patients presented optic neuritis, two patients had retinal vasculitis with CME; Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE), anterior uveitis and central scotoma were separately detected in the remaining three cases. The baseline mean visual acuity (± SD) was 0.3±0.1 (Snellen chart) for 8/9 patients, while in one case the visual acuity was limited to hand motion. 8/9 patients had bilateral ICG angiographic alterations. In 5 patients (10 eyes) the ICG angiogram showed focal hyperfluorescent spots both in the early and in the late phase. In 2 of these 5 cases neither the ophthalmoscopic fundus examination nor the fluorescein angiography were able to identify any retinochoroidal abnormality. A diffuse hyperfluorescent vascular sheathing was evident in two patients whilst a late optic nerve hyperfluorescence was observed in one case. All these angiographic alterations disappeared after specific medical treatment (penicillin or ceftriaxone). Conclusion: In this series 88% of the examined patients revealed ICG angiography alterations, mainly consisting of focal hyperfluorescent spots and hyperfluorescence of long traits of choroidal vessels. Therefore, ICG angiography may represent a valid diagnostic tool to confirm the suspicion of ocular syphilis.
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