Pournaras J-A C, Laffitte E, Guex-Crosier Y
Jules Gonin Eye Hospital, University of Lausanne, Lausanne, Switzerland.
Klin Monbl Augenheilkd. 2006 May;223(5):447-9. doi: 10.1055/s-2006-926579.
Giant retinal tears were previously described in patients affected by panuveitis. We report the case of a patient presenting giant retinal tears in both eyes affected by ocular syphilis.
A 45-year-old patient presented a 5 days history of sudden bilateral drop of vision, two weeks after penicillin therapy for secondary syphilis. The best visual acuity was 0.5 RE and light perception LE. Biomicroscopy showed an intense vitritis associated with bilateral giant tear and retinal detachment. Both TPHA and VDRL were positive. Lumbar puncture showed lymphoplasmocytosis with intrathecal synthesis of IgM.
Topical steroids treatment was applied and intravenous penicillin was given during 14 days. Pars plana vitrectomy with silicon oil tamponade was performed in association with endophotocoagulation in the left eye and cryocoagulation in the right eye. Vitreous PCR was negative. Evolution was successful with an attached retina.
This represents the first reported case of giant retinal tear with retinal detachment in a patient presenting a syphilitic panuveitis.
既往曾有全葡萄膜炎患者出现巨大视网膜裂孔的报道。我们报告1例双眼患有梅毒性葡萄膜炎并出现巨大视网膜裂孔的患者。
一名45岁患者，在接受二期梅毒青霉素治疗两周后，出现双眼视力突然下降5天的情况。最佳矫正视力右眼为0.5，左眼仅存光感。生物显微镜检查显示严重玻璃体炎，伴有双侧巨大裂孔和视网膜脱离。梅毒螺旋体血凝试验（TPHA）和性病研究实验室试验（VDRL）均为阳性。腰椎穿刺显示淋巴细胞和浆细胞增多，伴有鞘内IgM合成。
给予局部类固醇治疗，并静脉注射青霉素14天。左眼行玻璃体切除联合硅油填充及眼内光凝，右眼行冷冻治疗。玻璃体聚合酶链反应（PCR）结果为阴性。视网膜复位，病情进展顺利。
这是首例报道的患有梅毒性全葡萄膜炎的患者出现巨大视网膜裂孔并伴有视网膜脱离的病例。
