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Ruben Espino Icazbalceta, Alejandro Zermeno, Deisy Diarte, Miguel Pedroza-Seres; Clinical findings in immunocompetent patients diagnosed with Ocular Syphilis. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2183.
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© ARVO (1962-2015); The Authors (2016-present)
Syphilis is consider one of the great imitators of inflammatory ocular diseases. The purpose of this study it’s to describe the epidemiological data, systemic associations and clinical findings in patients later diagnosed with any form of Ocular Syphilis in the department of uveitis and ocular immunology at Instituto de Oftalmologia Conde de Valenciana, in Mexico City.
Retrospective study evaluating electronic database of the last 10 years (2007-2016), searching for patients with ocular syphilis with diagnosis confirmed by laboratory test. We correlated the variables: age, gender, suspected diagnosis at the time of the first visit, best corrected visual acuity at first and last visit, conjunctival and ocular surface signs, anterior and posterior segment findings, associated systemic diseases, IOP, complications, initial treatment and final diagnosis.We excluded patients with other systemic diseases that could potentially cause immunosuppression, like HIV, autoimmune diseases and tuberculosis.
We evaluated a total 89 eyes of 54 patients, 5 patients were excluded, 4 with diagnosis of HIV and 1 with tuberculosis. A total of 49 patients were included in this study, 33 female (67.3%) and 16 male (32.6%). The mean age was 56 years. The diagnosis was confirmed in all the patients with positive FTA-ABS analysis in two separate samples. The patient main complain at the first visit was blurred vision an visual impairment in 53% of the cases, the most common ocular finding was panuveitis in 51% of the cases, with an initial treatment with topic corticosteroids and tropicamide/phenylephrine in 55.1% of the patients. The clinical findings were conjunctival hyperemia in 38.7% of the cases, anterior chamber reaction in 65.3% of the patients and vitreous cells in 28.5%. The visual acuity was measured with a Snellen chart, 42.8% of the patients presented an improvement in visual acuity (defined as gaining 2 or more lines in the Snellen chart) after antibiotic treatment. 14 patients presented glaucoma associated with uveitis, only 2 required filtrating surgery.
Ocular Syphilis can present itself with a wide variety of ocular manifestations. It’s important for the ophthalmologist to suspect the diagnosis and always consider the use of laboratory tests in the event of a patient with uveitis or ocular inflammation.
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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