Prokosch V, Thanos S, Busse H, Stupp T
Universitätsaugenklinik, Universität Münster, Münster.
Klin Monbl Augenheilkd. 2009 Mar;226(3):184-8. doi: 10.1055/s-2008-1027867. Epub 2009 Mar 17.
The incidence of neurosyphilis, one of the late manifestations of syphilis, is reemerging. Affection of the eye is often associated with the disease. It may present with various clinical symptoms, leading to diagnostic difficulties. In cases of early diagnosis and adequate treatment the prognosis of the disease is good.
The purposes of this study are 1. to analyse clinical manifestations of patients with neurosyphilis on ophthalmological symptoms and 2. to demonstrate the course of the disease and the visual outcome in patients with optic nerve affection in neurosyphilis treated with standard therapy (penicillin G) or adjunct steroids.
We performed 1. a retrospective analysis of all 23 patients who were treated for neurosyphilis between 2000-2008 at this centre and 2. evaluated a case series of 4 patients with optic nerve affection in neurosyphilis who were treated with penicillin and adjunct methylprednisolone.
91% of the patients with neurosyphilis showed ocular affection in various presentations. The optic nerve was affected in 78%. In 43% ocular symptoms were the exclusive sign of the neurosyphilis. In all patients who were treated with penicillin, visual acuity improved. Adjunct treatment with methylprednisolone resulted in complete visual recovery in two cases.
Ocular symptoms serve as the key diagnostic findings in neurosyphilis. Treatment of choice is penicillin G. Adjunct treatment with methylprednisolone may improve the visual outcome in patients with optic nerve involvement.
梅毒的晚期表现之一神经梅毒的发病率正在再度出现。眼部受累常与该疾病相关。它可能呈现出各种临床症状，导致诊断困难。在早期诊断并进行充分治疗的情况下，该疾病的预后良好。
本研究的目的是1. 分析神经梅毒患者眼部症状的临床表现，以及2. 展示接受标准治疗（青霉素G）或辅助使用类固醇治疗的神经梅毒视神经受累患者的疾病进程和视力转归。
91%的神经梅毒患者出现了各种形式的眼部受累。78%的患者视神经受到影响。43%的患者眼部症状是神经梅毒的唯一体征。所有接受青霉素治疗的患者视力均有改善。辅助使用甲泼尼龙治疗使2例患者视力完全恢复。
眼部症状是神经梅毒的关键诊断依据。首选治疗药物是青霉素G。辅助使用甲泼尼龙治疗可能改善视神经受累患者的视力转归。
