Queiroz Rafael de Pinho, Diniz André Vasconcelos, Vasconcelos-Santos Daniel Vitor
Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Alfredo Balena 190. Sala 199, Belo Horizonte, MG, Brazil.
Hospital São Geraldo/HC-UFMG, Belo Horizonte, Brazil.
J Ophthalmic Inflamm Infect. 2016 Dec;6(1):6. doi: 10.1186/s12348-016-0075-2. Epub 2016 Feb 27.
Syphilis is a reemerging sexually transmitted disease that can lead to any type of intraocular inflammation. Prognosis of syphilitic uveitis after appropriate therapy is classically regarded as favorable. However, visual threatening complications may develop, rarely including rhegmatogenous/tractional retinal detachment (R/T RD) and proliferative vitreoretinopathy.
We report 4 patients presenting with complex R/T RD and fulminant proliferative vitreoretinopathy despite treatment among 19 patients with syphilitic posterior uveitis consecutively seen at our uveitis service. Most of these complications occurred during or shortly after antibiotic therapy. All patients presented with significant intraocular inflammation, including vitritis, occlusive retinal vasculitis, and retinal infiltrates (necrotizing retinochoroiditis in six eyes of four patients). Two patients (50 %) tested HIV positive, and the same proportion had inadvertently received high dose oral ± intravenous corticosteroids prior to diagnosis of syphilis. Two patients (three eyes) underwent RD surgical repair. Histopathology of an excised epiretinal membrane disclosed fibroglial tissue, with immature glial cells and metaplastic retinal pigment epithelium, admixed with lymphoplasmacytic infiltrate.
Syphilitic uveitis may be complicated by complex RD/fulminant fibroglial proliferation, occurring during/after treatment. Predisposing factors are currently unknown but may include prior use of corticosteroid, necrotizing retinitis and/or high spirochaetal load. A significant inflammatory component may underlie this fulminant fibroglial proliferation, being possibly amenable to modulation by aggressive anti-inflammatory therapy delivered concurrently with parenteral antibiotics.
梅毒是一种再度出现的性传播疾病，可导致任何类型的眼内炎症。传统上认为，适当治疗后梅毒葡萄膜炎的预后良好。然而，可能会出现威胁视力的并发症，很少包括孔源性/牵拉性视网膜脱离（R/T RD）和增殖性玻璃体视网膜病变。
我们报告了4例梅毒后葡萄膜炎患者，尽管接受了治疗，但仍出现了复杂的R/T RD和暴发性增殖性玻璃体视网膜病变，这些患者是在我们葡萄膜炎门诊连续就诊的19例患者中发现的。这些并发症大多发生在抗生素治疗期间或治疗后不久。所有患者均有明显的眼内炎症，包括玻璃体炎、闭塞性视网膜血管炎和视网膜浸润（4例患者的6只眼中有坏死性视网膜脉络膜炎）。2例患者（50%）HIV检测呈阳性，相同比例的患者在梅毒诊断前无意中接受了高剂量口服±静脉注射皮质类固醇。2例患者（3只眼）接受了视网膜脱离手术修复。切除的视网膜前膜的组织病理学显示为纤维胶质组织，有未成熟的胶质细胞和化生的视网膜色素上皮，伴有淋巴浆细胞浸润。
梅毒葡萄膜炎可能并发复杂的视网膜脱离/暴发性纤维胶质增生，发生在治疗期间/治疗后。目前尚不清楚诱发因素，但可能包括先前使用皮质类固醇、坏死性视网膜炎和/或高螺旋体负荷。这种暴发性纤维胶质增生可能有显著的炎症成分，可能可通过与肠胃外抗生素同时使用的积极抗炎治疗进行调节。
