Abstract
Purpose :
This observational case series investigates the visual outcomes in patients with syphilitic outer retinopathy treated with systemic steroids after IV Penicillin therapy. Steroids are effective in interstitial keratitis and cystoid macular edema secondary to syphilis. However, their role in syphilitic outer retinopathy, in the absence of other inflammatory ocular signs, remains underexplored.
Methods :
We conducted a comprehensive chart review of 14 eyes (7 patients) at our institution who, between 2020 and 2023, presented with signs and symptoms indicative of syphilitic outer retinopathy, confirmed via bloodwork. Symptoms included vision loss, blurry vision, headaches, and photopsias. Fundus autofluorescence (FAF) revealed punctate hyperfluorescent lesions in a granular/wreathlike pattern around the macula (Figure 1). These lesions were challenging to visualize on clinical fundus examination. Optical coherence tomography (OCT) showed a loss of ellipsoid zone with subretinal retinal pigment epithelium excrescences in the outer retina (Figure 2). After a positive syphilis screen and rapid plasma antigen test, patients underwent neurosyphilis evaluation and were treated with IV Penicillin G 4 million units Q4 hours for 2 weeks, followed by a tapered course of oral Prednisone (60mg for 1 week, 40mg for 3 days, 20mg for 3 days). We monitored visual acuity, OCT, and FAF changes.
Results :
The study included 4 males (57%) and 3 females (43%), averaging 43.2 years. 43% (6/14 eyes) had optic disc edema, but no anterior segment inflammation, vitritis, or cystoid macular edema was observed. None were HIV coinfected. Post-treatment, all patients showed improved LogMar visual acuity (average improvement 0.521 ± 0.459). FAF lesions, OCT findings, and optic disc edema resolved in all patients at follow-up (average duration 4.29 ± 2.54 months).
Conclusions :
This series emphasizes the potential of systemic steroids, alongside Penicillin, in treating syphilitic outer retinopathy. Without adverse steroid effects, patients exhibited significant visual acuity improvements, with most returning to baseline vision. These findings advocate for considering systemic steroids in managing sight-threatening infectious conditions like syphilis.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.