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Isabel Moreira Borelli, Claudio Zett Lobos, Gabriel Costa de Andrade, Cristina Muccioli; OCT angiography - new insights into an Ocular Syphilis outbreak in Brazil.. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1683. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
The characteristics of ocular syphilis may mimic many ocular diseases and have been well described clinically, as well as with fluorescein angiography (FA), indocyanine green angiography and optical coherence tomography (OCT) findings. OCT angiography (OCT-A) is a novel and non-invasive technique for imaging retinal microvasculature by detecting changes, with respect to time, in reflectivity related to blood flow. This study aims to report the OCT-A features of ocular syphilis.
In this prospective interventional case series study, 20 patients with ocular syphilis attended at the Ophthalmology Department of Federal University of Sao Paulo from March to October 2016. The diagnostic was based on clinical evaluation and results of both non-treponemal and treponemal serological exams. The patients underwent multimodal imaging , including OCT-A (Optovue RTVue XR AvantiR) and were treated with ceftriaxone (2 - 4 g daily IV for 14 days). Patients whose compliance with therapy or follow-up could not be ensured were excluded, likewise those with features obscuring the OCT A image. We herein describe the clinical manifestations, ancillary examination outcomes and new insights into ocular syphilis detected by OCT-A.
The diagnosis of ocular syphilis was made in 20 patients - 12 male and 8 female (average 45,60 years). 12 patients with low follow up compliance (10) and media opacities (2) were excluded, therefore, data for 16 eyes of 8 patients were analyzed. The symptoms, clinical presentation and 1 month outcomes are described in TABLE 1. The OCT-A features found include nonperfusion area of the superficial and deep retina plexus and choriocapillaris, hyperreflective dots on En Face OCT, flow density changes and perifoveal capillary arcade disruption in patients 1, 4 (FIGURE 1,2) and 6.
The OCT-A findings correlate with the hiperreflective dots noted on B-Scan and En face OCT, corroborating the theory that ischemia of the choriocapillaris may lead to the accumulation of subretinal metabolic residues (hiperreflective dots on En Face OCT) associated with low vision with improvement after specific treatment for syphilis. OCT-A seems to have the potential to increase our understanding of the ocular syphilis pathogenesis, although, further studies are needed to determine this reliability.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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