Eva X DeVience1, Sidney A Schechet2, Marcia Carney3, Mona Kaleem4, Stephen DeVience5, Luke Chang6, Michael Gerbo7, David M Hinkle7. 1. University of Maryland Baltimore Washington Medical Center, Baltimore, MD, USA. evadevience@gmail.com. 2. Elman Retina Group, Baltimore, MD, USA. 3. Eastern Virginia Medical School, Norfolk, VA, USA. 4. Wilmer Eye Institute, Bethesda, MD, USA. 5. Case Western Reserve University, Cleveland, OH, USA. 6. Department of Ophthalmology Medical College of Georgia Augusta University, Augusta, GA, USA. 7. West Virginia University Eye Institute, Morgantown, WV, USA.
Abstract
PURPOSE: To describe two distinct presentations of syphilitic fundus features in a series of patients with ocular syphilis. METHODS: This is a retrospective, interventional case series of 22 eyes from 16 serology confirmed cases. Clinical examination, fluorescein angiography, and optical coherence tomography were performed at presentation and following high-dose intravenous penicillin G. RESULTS: In our cohort, the mean age was 47.6 years (range 24-59 years) and 14 patients were male (87.5%), 11 patients were positive for human immunodeficiency virus (68.8%), and 6 had bilateral involvement (37.5%). Mean best-corrected visual acuity improved from 0.99 ± 0.79 logarithm of the minimal angle of resolution (LogMAR) at the time of presentation to 0.29 ± 0.36 LogMAR on final visit (P < 0.01). Posterior segment examinations in eyes with retinitis showed two distinct types (1) discrete, placoid lesions in the macula consistent with acute syphilitic posterior placoid chorioretinitis or (2) punctate inner retinitis with corresponding fluorescein pooling in a segmental pattern. These findings rapidly resolved after antibiotic therapy. CONCLUSION: In the era of resurgence, ocular syphilis may present with two phenotypes of discrete retinal lesions. Recognition of the characteristic ocular features may help make the diagnosis and monitor treatment response.
PURPOSE: To describe two distinct presentations of syphilitic fundus features in a series of patients with ocular syphilis. METHODS: This is a retrospective, interventional case series of 22 eyes from 16 serology confirmed cases. Clinical examination, fluorescein angiography, and optical coherence tomography were performed at presentation and following high-dose intravenous penicillin G. RESULTS: In our cohort, the mean age was 47.6 years (range 24-59 years) and 14 patients were male (87.5%), 11 patients were positive for human immunodeficiency virus (68.8%), and 6 had bilateral involvement (37.5%). Mean best-corrected visual acuity improved from 0.99 ± 0.79 logarithm of the minimal angle of resolution (LogMAR) at the time of presentation to 0.29 ± 0.36 LogMAR on final visit (P < 0.01). Posterior segment examinations in eyes with retinitis showed two distinct types (1) discrete, placoid lesions in the macula consistent with acute syphilitic posterior placoid chorioretinitis or (2) punctate inner retinitis with corresponding fluorescein pooling in a segmental pattern. These findings rapidly resolved after antibiotic therapy. CONCLUSION: In the era of resurgence, ocular syphilis may present with two phenotypes of discrete retinal lesions. Recognition of the characteristic ocular features may help make the diagnosis and monitor treatment response.
Authors: Genevieve F Oliver; Roy M Stathis; João M Furtado; Tiago E Arantes; Peter J McCluskey; Janet M Matthews; Justine R Smith Journal: Br J Ophthalmol Date: 2019-01-30 Impact factor: 4.638
Authors: Jonathan F Russell; Francesco Pichi; Nathan L Scott; Matthew J Hartley; Dugald Bell; Aniruddha Agarwal; Belinda Leong; Gary N Holland; K Bailey Freund; David Sarraf Journal: Int Ophthalmol Date: 2019-12-02 Impact factor: 2.031