Freigassner P S, El-Shabrawi Y
Univ.-Augenklinik Graz, Auenbruggerplatz 4, 8036 Graz/Osterreich.
Klin Monbl Augenheilkd. 2001 Oct;218(10):691-4. doi: 10.1055/s-2001-18393.
Due to increasing numbers of cases syphilis again becomes more important in ophthalmology. Syphilitic ocular manifestations do not show any typical characteristics and therefore are often not diagnosed although a correct and early diagnosis with adequate therapy is very important for the visual outcome.
We report on four patients with luetic ocular fundus manifestations, who were referred to our clinic with unspecific ocular complaints. Funduscopic examination revealed in all patients a papilledema, which was bilateral in three patients and unilateral in one patient. Additional findings were a non-granulomatous uveitis anterior and a chorioretinitis in both eyes of a 61-year-old HIV positive patient with retinal scars from a bilateral acute retinal necrosis syndrome (ARN), a mild non granulomatous iridocyclitis in a 53-year-old patient and a bilateral chorioretinitis and a cystoid macular edema in a 37-year-old patient. A 54-year-old patient showed a vein branch occlusion. Serological analysis demonstrated active syphilis in all cases and an EBV-infection in two patients. After penicillin therapy the ocular findings resolved.
In all cases of inflammatory fundus manifestations syphilis should be taken into consideration and serological lues tests should be performed routinely.
由于梅毒病例数量不断增加，其在眼科领域再次变得愈发重要。梅毒的眼部表现不具有任何典型特征，因此尽管正确且早期诊断并给予适当治疗对视力预后非常重要，但这些表现往往未被诊断出来。
我们报告了4例患有梅毒性眼底表现的患者，他们因非特异性眼部不适前来我院就诊。眼底检查发现所有患者均有视乳头水肿，其中3例为双侧，1例为单侧。其他发现包括：一名61岁的HIV阳性患者双眼出现非肉芽肿性前葡萄膜炎和脉络膜视网膜炎，伴有双侧急性视网膜坏死综合征（ARN）留下的视网膜瘢痕；一名53岁患者有轻度非肉芽肿性虹膜睫状体炎；一名37岁患者双眼出现脉络膜视网膜炎和黄斑囊样水肿。一名54岁患者出现静脉分支阻塞。血清学分析显示所有病例均为活动性梅毒，两名患者感染了EB病毒。青霉素治疗后眼部症状消失。
对于所有炎症性眼底表现的病例，均应考虑梅毒的可能，并常规进行梅毒血清学检测。
