Florence Hoogewoud1, Laure Frumholtz2, Paul Loubet3, Caroline Charlier4, Philippe Blanche5, David Lebeaux4, Nadjet Benhaddou6, Neila Sedira7, Laetitia Coutte5, Clelia Vanhaecke8, Odile Launay9, Claire Le Jeunne2, Emmanuel Héron7, Dominique Monnet1, Olivier Lortholary4, José-Alain Sahel10, Nicolas Dupin11, Antoine Brézin1, Marie-Hélène Errera10, Sawsen Salah1, Matthieu Groh12. 1. Department of Ophthalmology, National Referral Center for Rare Ocular Diseases, Hôpital Cochin, Paris, France. 2. Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Paris, France. 3. IAME, UMR 1137, INSERM, Hôpital Bichat, Paris, France; Department of Infectious Diseases, Hôpital Bichat-Claude Bernard, Paris, France. 4. Necker-Pasteur Center for Infectious Diseases and Tropical Medicine, Hôpital Necker Enfants Malades, Paris, France. 5. Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Paris, France; Department of Infectious Diseases, Hôpital Cochin, Paris, France. 6. National Referral Center for Syphilis, Hôpital Cochin, APHP, Paris, France. 7. Department of Internal Medicine, Centre Hospitalier National des Quinze-Vingt, Paris, France; DHU ViewMaintain, Sorbonne-Pierre et Marie Curie University, Paris, France. 8. Department of Dermatology, Hôpital Cochin, Paris, France. 9. Department of Infectious Diseases, Hôpital Cochin, Paris, France. 10. Department of Ophthalmology IV, Centre Hospitalier National des Quinze-Vingt, Paris, France; DHU ViewMaintain, Sorbonne-Pierre et Marie Curie University, Paris, France. 11. National Referral Center for Syphilis, Hôpital Cochin, APHP, Paris, France; Department of Dermatology, Hôpital Cochin, Paris, France. 12. Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Paris, France; Present address: Department of Internal Medicine, Hôpital St. Louis, Paris, France. Electronic address: matthieu.groh@aphp.fr.
Abstract
PURPOSE: To identify predictors of treatment success in syphilitic uveitis (SU). DESIGN: Retrospective multicentric analysis of patients treated for SU. PARTICIPANTS: A total of 95 eyes (66 patients, mean [standard deviation] aged 49 [12.5] years, 31 [47%] of whom were human immunodeficiency virus [HIV]+) were analyzed. METHODS: Activity of SU was assessed at 1 week and 1 month after treatment onset, and at last follow-up. Improvement was defined by a ≥2-step decrease of both anterior chamber and vitreous haze inflammation levels, and by the size reduction in chorioretinal lesions. MAIN OUTCOME MEASURES: Recovery was defined as the resolution of inflammation in all anatomic structures at 1 month. RESULTS: Panuveitis and posterior uveitis were the most frequent findings. Inflammatory parameters were higher in HIV+ patients. Recovery was reported in 65% and 85% of eyes at 1 month and at last follow-up, respectively. In multivariate analysis, after adjusting for initial best-corrected visual acuity and the antimicrobial treatment regimen, clinical improvement at 1 week (corrected risk ratios [cRR], 3.5 [2.3-3.8]; P = 0.001) was predictive of recovery at 1 month, whereas the use of periocular dexamethasone injections (cRR, 0.05 [0.02-0.6]; P = 0.01) and methylprednisolone pulses negatively affected the outcomes of eyes. CONCLUSIONS: Early improvement is the strongest predictor of ophthalmological recovery in SU.
PURPOSE: To identify predictors of treatment success in syphilitic uveitis (SU). DESIGN: Retrospective multicentric analysis of patients treated for SU. PARTICIPANTS: A total of 95 eyes (66 patients, mean [standard deviation] aged 49 [12.5] years, 31 [47%] of whom were human immunodeficiency virus [HIV]+) were analyzed. METHODS: Activity of SU was assessed at 1 week and 1 month after treatment onset, and at last follow-up. Improvement was defined by a ≥2-step decrease of both anterior chamber and vitreous haze inflammation levels, and by the size reduction in chorioretinal lesions. MAIN OUTCOME MEASURES: Recovery was defined as the resolution of inflammation in all anatomic structures at 1 month. RESULTS:Panuveitis and posterior uveitis were the most frequent findings. Inflammatory parameters were higher in HIV+ patients. Recovery was reported in 65% and 85% of eyes at 1 month and at last follow-up, respectively. In multivariate analysis, after adjusting for initial best-corrected visual acuity and the antimicrobial treatment regimen, clinical improvement at 1 week (corrected risk ratios [cRR], 3.5 [2.3-3.8]; P = 0.001) was predictive of recovery at 1 month, whereas the use of periocular dexamethasone injections (cRR, 0.05 [0.02-0.6]; P = 0.01) and methylprednisolone pulses negatively affected the outcomes of eyes. CONCLUSIONS: Early improvement is the strongest predictor of ophthalmological recovery in SU.
Authors: João M Furtado; Tiago E Arantes; Heloisa Nascimento; Daniel V Vasconcelos-Santos; Natalia Nogueira; Rafael de Pinho Queiroz; Luana P Brandão; Thaís Bastos; Ricardo Martinelli; Rodrigo C Santana; Cristina Muccioli; Rubens Belfort; Justine R Smith Journal: Sci Rep Date: 2018-08-13 Impact factor: 4.379