Department of Ophthalmology, University Hospital of Grenoble, Joseph Fourier University, Grenoble, France.
Graefes Arch Clin Exp Ophthalmol. 2010 Nov;248(11):1623-9. doi: 10.1007/s00417-010-1481-z. Epub 2010 Aug 12.
The ocular manifestations of syphilis are protean and can affect every structure of the eye. There has been a recent increase of syphilis infection in Europe. We report recent cases of ocular syphilis infection in a tertiary center.
During a 2.5-year period (2005-2007) we collected the medical records of eight male patients with ocular syphilis. The diagnosis was based on serological tests on blood samples and cerebrospinal fluid. All patients underwent a check-up to rule out another etiological diagnosis and to detect the presence of any other sexually transmitted infections.
The ocular lesions included: chorioretinitis (one case), retinitis (two cases), panuveitis with macular edema (two cases), episcleritis (one case), anterior optic neuritis (one case), and retrobulbar optic neuropathy (one case). Infection of the cerebrospinal fluid was detected in three of the five patients tested. In six cases, the inflammation was unilateral, and the anatomical and functional prognosis was excellent at the 6-month follow-up visit. Co-infection with human immunodeficiency virus was reported in five patients, with a CD4 T lymphocyte count greater than 300/mm(3). Most of the patients were treated with parenteral ceftriaxone (1 g daily) for 3 weeks with good tolerance. One patient was treated with intravenous penicillin G (18 MUI daily). Only one patient with anterior optic neuritis required systemic steroid therapy associated with antibiotics. Sequelae included sectorial atrophy of the optic nerve with visual field loss (n = 1) and abnormalities of the retinal pigment epithelium (n = 3).
All patients with ocular syphilis exhibited functional improvement and resolution of ocular inflammation after a specific antibiotic treatment. As a great imitator, syphilis should be considered in all patients with uveitis, scleritis, episcleritis, or optic neuritis, especially in men with high-risk sexual behavior.
梅毒的眼部表现形式多样，可影响眼部的每一个结构。近年来，欧洲的梅毒感染有所增加。我们报告了一家三级中心近期发生的眼部梅毒感染病例。
在 2.5 年的时间里（2005-2007 年），我们收集了 8 例眼部梅毒患者的病历。诊断基于血液样本和脑脊液的血清学检测。所有患者都接受了检查，以排除其他病因诊断，并检测是否存在任何其他性传播感染。
眼部病变包括：脉络膜视网膜炎（1 例）、视网膜炎（2 例）、全葡萄膜炎伴黄斑水肿（2 例）、表层巩膜炎（1 例）、前部视神经炎（1 例）和球后视神经炎（1 例）。在 5 例检测的患者中，有 3 例检测到脑脊液感染。在 6 例中，炎症是单侧的，在 6 个月的随访中，解剖和功能预后良好。5 例患者合并人类免疫缺陷病毒感染，CD4 T 淋巴细胞计数大于 300/mm3。大多数患者采用头孢曲松（1 g 每日）静脉注射治疗 3 周，耐受性良好。1 例前部视神经炎患者采用静脉注射青霉素 G（18 MU 每日）治疗。仅有 1 例前部视神经炎患者需要全身皮质类固醇治疗联合抗生素治疗。后遗症包括视神经扇形萎缩伴视野缺损（1 例）和视网膜色素上皮异常（3 例）。
所有眼部梅毒患者在接受特定抗生素治疗后，均表现出功能改善和眼部炎症消退。由于梅毒是一种“伟大的模仿者”，因此对于所有葡萄膜炎、巩膜炎、表层巩膜炎或视神经炎患者，尤其是有高风险性行为的男性患者，都应考虑梅毒的可能性。
