July 2018
Volume 59, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2018
Relatively delayed resolution of hyperautofluorescent lesions compared to central visual recovery in patients with acute syphilitic posterior placoid chorioretinitis
Author Affiliations & Notes
  • Sirichai Pasadhika
    Devers Eye Institute, Portland, Oregon, United States
  • James T. Rosenbaum
    Devers Eye Institute, Portland, Oregon, United States
    Casey Eye Institute, Portland, Oregon, United States
  • Footnotes
    Commercial Relationships   Sirichai Pasadhika, None; James Rosenbaum, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2018, Vol.59, 4644. doi:
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      Sirichai Pasadhika, James T. Rosenbaum; Relatively delayed resolution of hyperautofluorescent lesions compared to central visual recovery in patients with acute syphilitic posterior placoid chorioretinitis. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4644.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Syphilis rate has recently risen in the United States. Acute syphilitic posterior placoid chorioretinitis (ASPPC) is one of the most severe ocular manifestations. We report clinical characteristics at presentation and during recovery period, contrasting acuity with imaging findings.

Methods : This study is a retrospective review of 5 patients with ASPPC who underwent multi-modal imaging studies, including optical coherence tomography (OCT), ultra-widefield fundus photography, autofluorescence, and fluorescein angiography at presentation and/or during follow up.

Results : All 5 patients presented with sudden onset of decreased vision. Four men were known to have human immunodeficiency virus (HIV) infection, while one woman was sero-negative. Initial fundus examination and fluorescein angiograms showed posterior placoid lesions with optic disc edema and retinal vasculitis (predominantly phlebitis). Macular OCT images demonstrated irregular retinal pigment epithelial deposits with disruption of the ellipsoid zone. Variations of hyperautofluorescent lesions were observed. After treatment with intravenous antibiotics, central visual improvement can be observed during the first week, and further recovered with restoration of the ellipsoid zone on macular OCT in 6-8 weeks. Optic disc edema resolved in approximately 1-3 months. In contrast, hyperautofluorescent lesions may take months or years to resolve.

Conclusions : Improvement of hyperautofluorescent lesions in patients with ASPPC may significantly lag behind central visual recovery and restoration of macular ellipsoid anatomy. Therefore, persistent hyperautofluorescent lesions alone may not imply inadequate 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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