Moorfields Eye Hospital, London, United Kingdom.
Moorfields Eye Hospital, London, United Kingdom Royal London Hospital, Barts Health NHS Trust, London, United Kingdom.
Invest Ophthalmol Vis Sci. 2014 Jun 12;55(8):5394-400. doi: 10.1167/iovs.14-14559.
The British Ocular Syphilis Study (BOSS) is the first national prospective epidemiological study of intraocular syphilis (IOS) in light of the global increase in early syphilis (ES). The aims were to ascertain the UK incidence, demographics, clinical features, laboratory data, and posttreatment visual outcomes of patients with IOS.
Prospective study of IOS, reported through the national reporting system (British Ocular Surveillance Unit) from 2009 to 2011. Case definition was any adult presenting with intraocular inflammation in ES.
A total of 41 new cases (63 eyes) of IOS were reported, giving an annual incidence of 0.3 per million UK adult population. Mean age was 48.7 years (range, 20.6-75.1); 90.2% were male. All had RPR/VDRL titers of ≥1:16. Bilateral ocular involvement occurred in 56%; in unilateral cases, the left eye was more commonly affected (P = 0.009). Mean presenting logMAR visual acuity was 0.52 (20/63 Snellen; range, -0.2 to 2.30 logMAR). Panuveitis was the commonest diagnosis, seen in 41.3%, and isolated anterior uveitis was uncommon (9.5%). Subgroup analysis between HIV-positive and -negative patients found no significant differences in terms of proportion of bilateral disease, presenting or post treatment acuity. HIV-positive patients had higher rates of panuveitis. At final follow-up, 92.1% had visual acuity ≥ 0.3 logMAR (20/40 Snellen) after antibiotic therapy.
This study is the largest prospective series of ocular syphilis in the post-penicillin era. It confirms good visual outcomes for treated IOS, irrespective of HIV status or time to presentation. The study identified an unexpected preponderance for left eye involvement in uniocular cases; which is unexplained.
鉴于全球早期梅毒（ES）的增加，英国眼部梅毒研究（BOSS）是首次对眼内梅毒（IOS）进行的全国前瞻性流行病学研究。目的是确定英国 IOS 患者的发病率、人口统计学、临床特征、实验室数据和治疗后视力结果。
通过国家报告系统（英国眼部监测单位）从 2009 年至 2011 年对 IOS 进行前瞻性研究。病例定义为任何患有 ES 时出现眼内炎症的成年人。
共报告了 41 例（63 只眼）新的 IOS 病例，英国成人人口的年发病率为 0.3/百万。平均年龄为 48.7 岁（范围 20.6-75.1）；90.2%为男性。所有患者的 RPR/VDRL 滴度均≥1:16。56%的患者存在双眼受累；在单侧病例中，左眼更常受累（P=0.009）。初次就诊时平均 logMAR 视力为 0.52（20/63 Snellen；范围-0.2 至 2.30 logMAR）。最常见的诊断是全葡萄膜炎，占 41.3%，孤立性前葡萄膜炎罕见（9.5%）。对 HIV 阳性和阴性患者进行亚组分析发现，双侧疾病的比例、初次就诊时的视力或治疗后的视力无显著差异。HIV 阳性患者全葡萄膜炎的发生率更高。在最终随访时，92.1%的患者在接受抗生素治疗后视力≥0.3 logMAR（20/40 Snellen）。
本研究是青霉素后时代最大的眼部梅毒前瞻性系列研究。它证实了治疗 IOS 后视力良好，与 HIV 状态或就诊时间无关。研究发现单侧病例中左眼受累的比例异常高，但原因不明。
