Abstract
Purpose :
There is very little documented about the use of adjunctive steroids for uveitis associated with ocular syphilis. Because little evidence exists for the route of steroid treatment, we compared the effectiveness between the use of adjunctive topical steroids versus oral steroids. We performed a retrospective, clinical study to learn about the anatomic and visual outcomes in ocular syphilis patients treated with adjunctive topical steroids or oral steroids.
Methods :
Nine male patients aged 26 to 72 years old were identified with a diagnosis of ocular syphilis by a positive RPR, positive treponemal IgG/IgM, with associated bilateral anterior or posterior chamber inflammation. All patients were treated with IV penicillin and topical prednisolone acetate or high dose oral prednisone. Six patients were found to be treated with topical prednisolone acetate 1-2 days after starting treatment with penicillin. Three patients were treated with high dose oral prednisone 1-2 days after starting treatment with penicillin. Visual acuity and slit lamp findings (cells and flare) were documented at presentation. Outcomes were visual acuity and slit lamp findings at discharge from the hospital or first clinic follow up after discharge.
Results :
Patients in the topical steroids group had an average presenting visual acuity of 20/400. There was improvement to 20/100 at a mean follow up of 16.1 days. Patients in the oral steroids group had an initial visual acuity of 20/100. There was visual improvement to 20/25 at a mean follow up of 8.3 days. Qualitatively, there was significant improvement of ocular inflammation in both groups, but there was swifter improvement in the oral steroids group.
Conclusions :
There was a noticeable increase in the rate of improvement of visual and anatomical recovery in ocular syphilis patients treated with oral steroids in the short term. Also, average recovered visual acuity in the oral steroids group was significantly better than the topical group, although, the starting average visual acuity was worse in the topical group. However, this is a small study, and we are looking to expand our sample size to other sites. Furthermore, many of the patients were lost to follow up and more studies need to be performed to assess long term outcome.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.