June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
Quantification of ellipsoid zone recovery by optical coherence tomography following intravenous penicillin treatment in syphilitic retinitis patients
Author Affiliations & Notes
  • Michael Ramos
    Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
  • Cindy Chen
    Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
  • Sumit Sharma
    Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
  • Kimberly Baynes
    Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
  • Ashley Lowe
    Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
  • Kayvan Barekatain
    Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
  • Jasmin Bhangu
    Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
  • Phuoc-Hanh Le
    Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
  • Danielle Burton
    Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
  • Justis P Ehlers
    Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
  • Sunil K. Srivastava
    Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
  • Footnotes
    Commercial Relationships   Michael Ramos, None; Cindy Chen, None; Sumit Sharma, Alimera (C), Allergan (C), Bausch and Lomb (C), Clearside (C), Eyepoint (C), Genentech (C), Regeneron Pharmaceuticals (C); Kimberly Baynes, None; Ashley Lowe, None; Kayvan Barekatain, None; Jasmin Bhangu, None; Phuoc-Hanh Le, None; Danielle Burton, None; Justis Ehlers, Aerpio (C), Alcon (C), Allegro (C), Allergan (C), Genentech (C), Leica (C), Novartis (C), Oxurion (C), Regeneron (C), Roche (C), Santen (C), Zeiss (C); Sunil K. Srivastava, Abbvie (C), Allergan (F), Bausch and Lomb (C), Eyepoint (C), Eyevensys (C), Novartis (C), Regeneron (C), Santen (F), Zeiss (C)
  • Footnotes
    Support  NIH-NEI P30 Core Grant (IP30EY025585); Unrestricted Grants from The Research to Prevent Blindness, Inc.; Cleveland Eye Bank Foundation
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 2437. doi:
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      Michael Ramos, Cindy Chen, Sumit Sharma, Kimberly Baynes, Ashley Lowe, Kayvan Barekatain, Jasmin Bhangu, Phuoc-Hanh Le, Danielle Burton, Justis P Ehlers, Sunil K. Srivastava; Quantification of ellipsoid zone recovery by optical coherence tomography following intravenous penicillin treatment in syphilitic retinitis patients. Invest. Ophthalmol. Vis. Sci. 2021;62(8):2437.

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

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Abstract

Purpose : Spectral-domain optical coherence tomography (SD-OCT) has proven useful in defining the retinal layer pathology, most notably ellipsoid zone (EZ) disruption, seen in syphilitic retinitis patients; however, a timeline for EZ recovery after intravenous (IV) penicillin treatment in these patients has yet to be established. Here, we report an SD-OCT image analysis study of syphilitic retinitis patients to quantify EZ recovery in a time-dependent manner to determine successful outcomes in this patient population.

Methods : A retrospective chart review of 8 patients diagnosed with syphilitic retinitis was performed. A positive diagnosis included reactive syphilis IgG (>8.0) and rapid plasma reagin (RPR) serological tests and was confirmed by ocular exam. All patients were treated with at least a 14-day course of IV penicillin. Patients had a baseline SD-OCT scan of the diseased eye(s) within 7 days of treatment initiation and at least one scan during the treatment course. All SD-OCT scans up to 45 days post-baseline were analyzed using software that allowed for total EZ volume quantification following retinal layer segmentation. Clinical information, such as disease laterality, HIV status, and visual acuity, were also collected.

Results : Of the 8 patients with confirmed syphilitic retinitis, 4 showed bilateral disease. 7/8 patients had macular EZ disruption, while 1 patient showed peripheral retinal changes consistent with syphilis. 5/8 patients (62.5%) were HIV+ at the time of presentation. In patients with macular involvement, 10/13 eyes were analyzed. Throughout IV treatment, the average change from baseline in total EZ volume was +15.6%; however, this change was variable (range, -20.2% - +48.0%). Patients saw a more consistent improvement once treatment was completed. At a mean follow-up time of 15.7 days after treatment, patients showed an average increase of 73.0% (range, 53.6 - 122.8%) in total EZ volume.

Conclusions : With this study, we have shown that the EZ disruption seen on SD-OCT in syphilitic retinitis patients is a temporary pathological finding and can be resolved with IV penicillin. Furthermore, while EZ recovery begins during a patient’s treatment course, most of the recovery is observed in the weeks following the conclusion of intravenous therapy.

This is a 2021 ARVO Annual Meeting abstract.

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