Inoue Shinya, Nishimura Tomoharu, Takanashi Noriko, Machida Shigeki
Department of Ophthalmology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan.
Doc Ophthalmol. 2020 Oct;141(2):187-193. doi: 10.1007/s10633-020-09763-2. Epub 2020 Apr 4.
We present our findings in two cases of retinal dysfunction caused by syphilitic outer retinopathy. CASE 1: A 59-year-old man visited our clinic complaining of blurred vision in his left eye. Optical coherence tomography (OCT) demonstrated an absence of the ellipsoid zone (EZ) in the left eye. A round yellowish-white lesion was observed in the posterior pole of the left fundus. Fundus autofluorescence (FAF) showed hyperfluorescent areas in the posterior pole of both fundi although no specific ophthalmoscopic findings were seen in the right eye. The amplitudes of the LA 3.0 1 Hz and LA 3.0 30 Hz ERG responses were reduced with better preservation of the rod responses. Based on a strong positivity to the rapid plasma reagin (RPR) assay and the Treponema pallidum hemagglutination (TPHA) test, he was diagnosed with syphilitic outer retinopathy and treated with systemic antibiotics. The treatment resulted in a restoration of the retinal structures and cone function. CASE 2: A 47-year-old man was referred to our clinic complaining of reduced vision in both eyes. Although the ocular fundus appeared normal, FAF showed a diffuse hyperfluorescent area in the posterior pole and multiple hyperfluorescent spots. Indocyanine green angiography showed multiple confluent areas of hypofluorescence. OCT demonstrated irregular EZs in both eyes. The amplitudes of the LA 3.0 1 Hz and LA 3.0 30 Hz ERG responses were slightly reduced with prolonged implicit times. These findings are comparable to the findings in patients with multiple evanescent white dot syndrome. However, the strong positivity to the RPR and TPHA tests led us to diagnose the patient with outer retinopathy caused by syphilis. Systemic administration of antibiotics resulted in the restoration of the retinal structures and retinal function.
Syphilitic outer retinopathy affected the retinal structures and function that can be restored by antibiotic treatments.
我们展示两例由梅毒性外层视网膜病变引起的视网膜功能障碍的病例研究结果。病例1：一名59岁男性因左眼视力模糊前来就诊。光学相干断层扫描（OCT）显示左眼椭圆体带（EZ）缺失。左眼眼底后极部可见一个圆形黄白色病变。眼底自发荧光（FAF）显示双眼后极部均有高荧光区，尽管右眼未发现特异性眼底病变。左眼3.0 1Hz和3.0 30Hz的闪光视网膜电图（ERG）反应振幅降低，而视杆细胞反应保存较好。基于快速血浆反应素（RPR）试验和梅毒螺旋体血凝试验（TPHA）呈强阳性，该患者被诊断为梅毒性外层视网膜病变，并接受了全身抗生素治疗。治疗后视网膜结构和视锥细胞功能得以恢复。病例2：一名47岁男性因双眼视力下降转诊至我院。尽管眼底外观正常，但FAF显示后极部有弥漫性高荧光区和多个高荧光斑点。吲哚菁绿血管造影显示多个融合的低荧光区。OCT显示双眼EZ不规则。左眼3.0 1Hz和3.0 30Hz的ERG反应振幅略有降低，潜伏期延长。这些表现与多灶性一过性白点综合征患者的表现相似。然而，RPR和TPHA试验呈强阳性，使我们诊断该患者为梅毒引起的外层视网膜病变。全身应用抗生素后，视网膜结构和功能得以恢复。
梅毒性外层视网膜病变可影响视网膜结构和功能，抗生素治疗可使其恢复。
