Abstract
Purpose :
Limited studies have characterized ocular syphilis, a rare but serious complication of syphilis infection that may lead to vision loss and blindness. We performed a retrospective review to describe the clinical manifestations and visual outcomes of patients with ocular syphilis.
Methods :
We reviewed the electronic medical records of patients with ocular syphilis who presented to Weill Cornell Ophthalmology from 2013 to 2018. Inclusion criteria were patients with uveitis on exam and positive syphilis serology. Patients with positive serology for other etiologies were excluded. Demographics, presenting symptoms, and ocular exam findings including fluorescein angiography (FA) and optical coherence tomography (OCT) were collected. Descriptive analysis was performed using SAS statistical software. Best Corrected Visual Acuity (BCVA) was converted to the logarithm of the minimum angle of resolution (LogMAR) for analysis. Visual outcomes were measured by BCVA at follow-up visit after standard neurosyphilis treatment.
Results :
Eight patients (13 eyes) were identified within a 5 year period. Patients were predominantly male (87.5%), and mean age was 48 years (range 37-60). 62.50% of patients presented with bilateral ocular involvement. Coinfection with Human Immunodeficiency Virus (HIV) occurred in 50% of patients, and 50% were men who had a history of sex with men (MSM). The most common complaints at presentation were vision loss and photopsia (both 75%), followed by pain and light sensitivity (both 37%), followed by headaches, redness, and scotoma (all 25%). Upon examination of 13 eyes, the most common findings included vitreous cells (100%), anterior chamber flare (61%) and cells (49%), and optic disc hyperemia (58.33%, n=12). Additional findings included disc edema (41.67%, n=12), vasculitis and choroidal lesions (both 41.67%, n=12), corneal keratic precipitates (30.77%), and retinal pigment epithelium mottling or irregularity (33.33%, n=12). On OCT and FA, the most common findings were an ill-defined junction of the photoreceptor inner and outer segments (25%, n=12), and retinal vascular leakage (50%, n=10), respectively. Mean visual acuity upon presentation was 0.74 +/- 0.9 (mean +/- SD, LogMAR), and significantly improved to 0.32 +/- 0.8 after treatment (p=0.0223).
Conclusions :
Ocular syphilis presented with a wide spectrum of clinical manifestations and involved a variety of ocular structures. Treatment improved visual outcomes.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.