Gass J D, Braunstein R A, Chenoweth R G
Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, FL 33101.
Ophthalmology. 1990 Oct;97(10):1288-97. doi: 10.1016/s0161-6420(90)32418-1.
Six patients with evidence of secondary syphilis presented with visual loss in both eyes caused by large, placoid, yellowish lesions with faded centers at the level of the pigment epithelium in the macula and juxtapapillary areas. All eyes had vitreitis. All of the lesions showed a similar fluorescein angiographic pattern of early hypofluorescence and late staining. Five patients had mucocutaneous lesions typical of secondary syphilis. All five patients treated with antibiotics had prompt improvement in visual function and resolution of the fundus lesions. The ophthalmoscopic and angiographic appearance of these posterior fundus lesions was sufficiently characteristic to suggest a diagnosis of secondary syphilis. Modification of the host response to syphilis by human immune deficiency virus (HIV) infection may be partly responsible for this peculiar fundus picture. Three of the four patients tested positive for HIV.
6例二期梅毒患者出现双眼视力丧失，其黄斑和视乳头周围区域色素上皮层有大的、扁平状、淡黄色且中心褪色的病变。所有患眼均有玻璃体炎。所有病变在荧光素血管造影中均表现出早期低荧光和晚期染色的相似模式。5例患者有二期梅毒典型的黏膜皮肤损害。所有5例接受抗生素治疗的患者视觉功能迅速改善，眼底病变消退。这些眼底后部病变的检眼镜和血管造影表现具有足够的特征性，提示二期梅毒的诊断。人类免疫缺陷病毒（HIV）感染对梅毒宿主反应的改变可能部分导致了这种特殊的眼底表现。4例接受检测的患者中有3例HIV检测呈阳性。
