Flinders University, Adelaide, South Australia, Australia.
University of São Paulo, Ribeirão Preto, Brazil.
Br J Ophthalmol. 2019 Nov;103(11):1645-1649. doi: 10.1136/bjophthalmol-2018-313207. Epub 2019 Jan 30.
Syphilitic uveitis is re-emerging alongside the systemic infection. In July 2017, an international group of uveitis-specialised ophthalmologists formed the International Ocular Syphilis Study Group to define current practice patterns.
103 Study Group members based in 35 countries completed a 25-item questionnaire focused on case load, clinical presentations, use and interpretation of investigations, treatment and clinical indicators of poor prognosis.
Members managed a mean of 6.1 patients with syphilitic uveitis in clinics that averaged 707 annual cases of uveitis (0.9%); 53.2% reported increasing numbers over the past decade. Patients presented to more members (40.2%) during secondary syphilis. Uveitis was usually posterior (60.8%) or pan (22.5%); complications included optic neuropathy, macular oedema and posterior synechiae. All members diagnosed syphilitic uveitis using serological tests (simultaneous or sequential testing algorithms), and 97.0% routinely checked for HIV co-infection. Cerebrospinal fluid (CSF) analysis was ordered by 90.2% of members, and 92.7% took uveitis plus Venereal Disease Research Laboratory test (VDRL) or fluorescent treponemal antibody absorption test (FTA-ABS) to indicate neurosyphilis. Patients were commonly co-managed with infectious disease physicians, and treated with penicillin for at least 10-14 days, plus corticosteroid. Features predicting poor outcome included optic neuropathy (86.3%) and initial misdiagnosis (63.7%). Reasons for delayed diagnosis were often practitioner-related. 82.5% of members tested every patient they managed with uveitis for syphilis.
This comprehensive report by an international group of uveitis-specialised ophthalmologists provides a current approach for the management of syphilitic uveitis.
梅毒性葡萄膜炎随着全身感染再次出现。2017 年 7 月，一个由葡萄膜炎眼病专家组成的国际团体成立了国际眼部梅毒研究组，以确定当前的实践模式。
35 个国家的 103 名研究小组成员完成了一份 25 项的调查问卷，重点关注病例数量、临床表现、检查的使用和解释、治疗以及预后不良的临床指标。
成员们在平均每年有 707 例葡萄膜炎（0.9%）的诊所中，平均管理 6.1 例梅毒性葡萄膜炎患者；过去十年中，有 53.2%的人报告患者数量增加。患者在二期梅毒时更多地向成员（40.2%）就诊。葡萄膜炎通常为后部（60.8%）或全葡萄膜炎（22.5%）；并发症包括视神经病变、黄斑水肿和后粘连。所有成员都使用血清学检测（同时或序贯检测算法）诊断梅毒性葡萄膜炎，97.0%的成员常规检查是否合并 HIV 感染。90.2%的成员要求进行脑脊液（CSF）分析，92.7%的成员进行葡萄膜炎和性病研究实验室试验（VDRL）或荧光密螺旋体抗体吸收试验（FTA-ABS）以确定神经梅毒。患者通常与传染病医生共同管理，接受至少 10-14 天的青霉素治疗，加用皮质类固醇。预测不良预后的特征包括视神经病变（86.3%）和初始误诊（63.7%）。延迟诊断的原因通常与医生有关。82.5%的成员对他们管理的每一位葡萄膜炎患者进行梅毒检测。
这份由国际葡萄膜炎眼病专家组成的综合报告为梅毒性葡萄膜炎的治疗提供了当前的方法。
