Functional and structural changes in treated ocular syphilis

Abstract

Purpose : To report functional and structural changes in treated ocular syphilis.

Methods : 48 eyes from 29 patients who presented consecutively with syphilitic maculopathy and were treated with antibiotics according to CDC recommendations were included. Ophthalmic evaluation included pre- and post-treatment best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (SD-OCT, Heidelberg), and post-treatment contrast sensitivity (SpotChecks, PrecisionVision), microperimetry (MAIA, CenterVUE), Adaptive Optics (AO) RTX1 retinal imaging (Imagine Eyes) and multifocal electroretinography (mfERG, Diagnosys LLC). For AO analyses, eyes with clinical disease were compared to those with no signs of syphilitic maculopathy.

Results : OCT data were available in 46 eyes: epiretinal membrane was observed in 15 eyes before and 23 after treatment (p = 0.089), while macular edema was found in 15 eyes and in 6 eyes after treatment (p = 0.025). Retinal pigment epithelial irregularity and ellipsoid zone disruption (EZ) were present in 29 and 13 eyes, and 14 and 10 eyes pre- and post-treatment (p <0.01 and >0.05), respectively. Four eyes had light perception (LP) or no LP vision before and after treatment; the remaining eyes showed mean BCVA of 0.8±0.1 logMAR before treatment and 0.3±0.1 logMAR after treatment (p<0.01). Contrast sensitivity was 1.7±0.05 dB post-treatment, correlating with post-treatment BCVA (r=0.82, p<0.01). mfERG showed focal amplitude reduction, with sensitivity lost on microperimetry in 44 eyes. Analysis of covariance showed pre-treatment EZ disruption on OCT impacted post-treatment BCVA (p=0.0195) and contrast sensitivity (p=0.006). 16 eyes had images suitable for AO analysis of photoreceptors. The comparison between mean cone density of eyes that had clinical manifestations (12 eyes) versus those that did not (4 eyes) in 90x90 and 64x64 µm squares demonstrated that the former group had lower values (mean 9.682±4.348 and 13.137±4.412 cells/mm² versus 16.086±2.500 and 18.101±5.210 cells/mm², respectively.

Conclusions :
Patients with ocular syphilis suffer from multiple functional and structural macular changes, even after appropriate antibiotic treatment.

This is a 2020 ARVO Annual Meeting abstract.