Herbort Carl P, Papasavvas Ioannis, Mantovani Alessandro
Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialised Care, Clinic Montchoisi Teaching Centre, Lausanne, Switzerland.
Department of Ophthalmology, Ospedale Valduce, Como, Italy.
J Curr Ophthalmol. 2020 Dec 12;32(4):381-389. doi: 10.4103/JOCO.JOCO_184_20. eCollection 2020 Oct-Dec.
To evaluate the multimodal imaging of acute syphilitic posterior placoid chorioretinitis (ASPPC) lesions in order to elucidate their pathophysiology which seems to resemble choriocapillaritis as in primary inflammatory choriocapillaropathies such as multifocal choroiditis (MFC) and acute posterior multifocal placoid pigment epitheliopathy (APMPPE).
Charts of patients with ASPPC seen in the Centre for Ophthalmic Specialised Care, Lausanne, Switzerland, were retrieved. Fundus autofluorescence (FAF), spectral domain optical coherence tomography (SD-OCT), fluorescein angiography (FA), indocyanine green angiography (ICGA), and when available, OCT angiography were analyzed and compared to a case of MFC.
One woman aged 58 and 2 men aged 50 and 31 with unilateral ASPPC were analyzed. All had positive syphilis serologies (venereal disease research laboratory [VDRL] and treponema Pallidum hemagglutination assay [TPHA]). Two were human immunodeficiency virus (HIV) positive. Mean best corrected visual acuity was 0.2 ± 0.1 at presentation and 1.0 for all patients 6 weeks later, after antibiotic treatment for neurosyphilis. All had central scotomata with a mean defect (MD) of 12.2 ± 2.6. Six weeks later, MD values were 3.9 ± 1.7. Microperimetry had a mean score of 25/560 at presentation and recovered to a mean of 444/560 6 weeks later. Multimodal imaging features consisted of FA tissue staining, ICGA hypofluorescent choriocapillaris non-perfusion, FAF hyperautofluorescence, and loss of the ellipsoid line in the diseased areas. The findings were consistent and identical in ASPPC and a case of MFC and pointed toward the involvement of the choriocapillaris.
Similarities seen in multimodal imaging features in ASPPC and choriocapillaritis highlight the role of the choriocapillaris in the pathophysiologic mechanism of both conditions. Inflammatory choriocapillaris non-perfusion triggered by infectious agents seems to be the common pathway through which the eye is reacting.
评估急性梅毒性后极部扁平状脉络膜视网膜病变（ASPPC）病变的多模态成像，以阐明其病理生理学机制，该机制似乎类似于原发性炎症性脉络膜毛细血管病变（如多灶性脉络膜炎（MFC）和急性后极部多灶性扁平状色素上皮病变（APMPPE））中的脉络膜毛细血管炎。
检索了在瑞士洛桑眼科专科医院就诊的ASPPC患者的病历。对眼底自发荧光（FAF）、光谱域光学相干断层扫描（SD-OCT）、荧光素血管造影（FA）、吲哚菁绿血管造影（ICGA），以及在可获得的情况下对OCT血管造影进行了分析，并与1例MFC病例进行了比较。
分析了1例58岁女性和2例分别为50岁和31岁的男性单侧ASPPC患者。所有患者梅毒血清学检查（性病研究实验室试验[VDRL]和梅毒螺旋体血凝试验[TPHA]）均为阳性。2例为人类免疫缺陷病毒（HIV）阳性。初诊时平均最佳矫正视力为0.2±0.1，在接受神经梅毒抗生素治疗6周后，所有患者的视力均为1.0。所有患者均有中心暗点，平均缺损（MD）为12.2±2.6。6周后，MD值为3.9±1.7。微视野检查初诊时平均得分为25/560，6周后恢复至平均444/560。多模态成像特征包括FA组织染色、ICGA脉络膜毛细血管低荧光无灌注、FAF高自发荧光以及病变区域椭圆体带缺失。ASPPC和1例MFC病例的检查结果一致且相同，提示脉络膜毛细血管受累。
ASPPC和脉络膜毛细血管炎在多模态成像特征上的相似性突出了脉络膜毛细血管在这两种疾病病理生理机制中的作用。由感染因子触发的炎症性脉络膜毛细血管无灌注似乎是眼部反应的共同途径。
