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JORGE ARTURO AGUILERA PARTIDA, Mariana Ingolotti, Bernardo Ariel Schlaen, Perla Monserrat Madrigal-Ruiz, Humberto Ruiz-Garcia; Multimodal imaging in Syphilitic Uveitis. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1522. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To determine and describe specific findings using multimodality exams in active and resolved syphilitic uveitis.
This is a retrospective study. Patient record with clinical and laboratory findings consistent with the diagnosis of syphilis were reviewed at a private practice setting in Mexico, between June 2016 to October 2017. Age, gender, uveitis classification, HIV serology and best corrected visual acuity (BCVA) before and after treatment. Multimodal exam comprised: fundus fluorescein angiography (FFA), blue light fundus autofluorescence (FAF), structural optical coherence tomography (SD-OCT), en-face optical coherence tomography and optical coherence tomography angiography (OCTA). Imaging findings in active and inactive disease were recorded. Chi square was performed for statistical analysis.
Eighteen eyes of nine patients with posterior uveitis and panuveitis were included. Average age was 37.67 ± 13.87 years. Median follow-up was 60.71 ± 49.57 days. Five patients were HIV positive. Media BCVA at presentation was 0.6 ± 0.87 LogMAR and post treatment 0.14 ± 0.09 LogMAR. Autofluorescence showed a granular pattern (83.3%) and loss of foveal hypoautofluorescence temporally (55.6%) in cases with active disease (P=0.05). Nodular thickening of the retinal pigment epithelium (RPE) in SD-OCT was present in 50% of the eyes with active disease. Capillaritis, papillitis and delayed patched choroidal filling were the more frequent (66.7%) signs in the FFA. OCTA could be obtained in 6 eyes and demonstrated diffuse attenuation of deep capillary plexus and a peculiar terminal bulb-like dilatation in superficial plexus accompanied by a broken branch vessel pattern. En face OCT in active disease showed a singular pattern of lesions, which were hyperreflective dots that co-localized with the areas of nodular thickening of the RPE.
Multimodal imaging of syphilitic uveitis reveals a group of unique findings that, put together, can help in increasing the clinical suspicion of the disease as well as determine response to treatment.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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