Abstract
Purpose :
Since 2000, the incidence of syphilis has quadrupled in the United States. Although Acute Syphilitic Posterior Placoid Chorioretinitis (ASPPC) has been well-defined diagnostically, the visual outcomes after treatment have not been well-described. The purpose of this retrospective, observational study was to summarize presenting features as well as outcomes after treatment in eyes with ASPPC.
Methods :
A single-center chart review of 24 eyes of 17 patients (age≥18) with ASPPC who presented to the University of Michigan Kellogg Eye Center between January 1, 2012 and November 4, 2022. Eyes with comorbid vision-threatening disease were excluded. Demographic, medical history, and ophthalmology visit information including best corrected visual acuity (BCVA), lesion location, and relevant imaging including optical coherence tomography (OCT) were reviewed. Data were analyzed using descriptive statistics.
Results :
Median age at presentation was 46 [Interquartile range (IQR):38, 51]. Eight eyes (33.3%) were previously misdiagnosed. The posterior pole was involved in 16 (66.6%) eyes. All patients received 14 days of intravenous Penicillin G 24 million units/day. At presentation, 20 (83.3%) eyes had subjectively reduced vision confirmed by BCVA ≤ 20/25 snellen (0.096 Logarithm of the Minimum Angle of Resolution (LogMAR)); median BCVA was 0.60 (±0.47). Median LogMAR BCVA at 45 and 100 days were 0.096 [IQR:0.02, 0.17] and 0.096 [IQR:0.04, 0.13], respectively. Median time to the best BCVA achieved at any point after treatment was 35.5 days [IQR: 22.7, 56.7]. At initial and final visits at our institution, pyramidal hyper-reflective foci in retinal pigment epithelium were present on OCTs of 18 (75%) and 4 (16.7%) eyes, respectively. Twenty (83.3%) eyes had disruption of the ellipsoid zone (EZ), 15 (62.5%) of which were sub-foveal. Of these, 8 (40%) had complete and 13 (65%) had sub-foveal EZ recovery. The median time from treatment completion to complete and sub-foveal EZ recovery were 135.5 [IQR: 30.5, 249.7] and 15 [IQR: 6, 31] days, respectively. Three (17.6%) patients were lost to follow-up.
Conclusions :
This study of patients with ASPPC who underwent intravenous Penicillin G treatment showed that symptomatic eyes improved from a median snellen BCVA of 20/80 on presentation to 20/25 at 45 days. These findings provide refined guidance for counseling patients who present with decreased vision due to ASPPC.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.