Abstract
Purpose :
Syphilis is a sexually transmitted disease whose incidence has increased in the last years. Although ocular involvement is rare, in some cases it can be the only manifestation. The aim of the study was to describe the sequence of retinal structural changes from presentation to resolution of acute syphilitic posterior placoid chorioretinitis (ASPPC) using different imaging modalities.
Methods :
Retrospective review of consecutive patients with a new diagnosis of ocular syphilis from August 2018 to August 2019. Best corrected visual acuity (BCVA) was recorded at the diagnosis and during follow-up. Multimodal imaging performed in all patients at diagnose and follow-up included: spectral domain optic coherence tomography (SD-OCT), fundus autofluorescence (FAF) and fundus fluorescein angiography (FFA). Diagnose was based on clinical manifestations and serologic study of non-treponemal (RPR) and treponemal (TPHA) tests.
Results :
Ten eyes of 6 patients were included in the study, 4 of them affected bilaterally and 2 unilaterally. All patients were males, with a mean age at onset of 45.8 years (range: 33-71). 4/6 were homosexual and 3/6 were co-infected with HIV. All patients presented with ASPPC. All patient presented with decreased visual acuity and central scotomas. Mean BCVA was 0.17 logMAR (range 0.0-1.0) at diagnose and 0.01 (range 0.0-0.1) after treatment. 5/6 presented with yellowish placoid lesions on funduscopy, and 4/6 associated bilateral disc edema. 1/6 patient presented with panuveitis. Macular SD-OCT images showed disruption of ellipsoid zone and granular hyper-reflectivity of the retinal pigment epithelium in all patients. FAF presented peripapilar and macular hyper-autofluorescent areas. Early hipofluoresence and late hyperfluorescence of the lesions and optic nerve leakage in the patients with papillitis were observed on FFA. Nontreponemal (RPR) and treponemal (TPHA) tests yielded positive results in all patients. All received intravenous Penicillin G for two weeks. Complete clinical and image resolution was observed at 1 month follow-up.
Conclusions :
Although ASPPC is a rare manifestation of syphilis, it is the most common presentation form in our population. Multimodal imaging provides useful information to help the clinician during the diagnosis and follow-up. Prompt treatment restores visual acuity and structural changes seen in multimodal imaging.
This is a 2020 ARVO Annual Meeting abstract.