Eye Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
Custom Service Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
Front Immunol. 2022 Jun 10;13:910337. doi: 10.3389/fimmu.2022.910337. eCollection 2022.
To report the demographic, clinical, and laboratory characteristics of ocular syphilis based on a 6-year case series study from an eye center in East-China.
A total of 131 cases (191 eyes) of ocular syphilis and the annual number of total syphilis cases from January 2016 to December 2021, were included in this study. Detailed medical records including systemic and ophthalmic medical history, a complete ophthalmic examination, color fundus photography, B-type ultrasound, fundus fluorescein angiography (FFA), spectral domain optical coherence tomography (SD-OCT), laboratory tests of the serum and cerebrospinal fluid (CSF) samples, as well as visual field test and orbital or cranial MRI in cases with suspected optic neuritis or optic atrophy, were collected and analyzed. Pearson Chi-square or Fisher's exact tests was used for statistics analysis.
Of the 131 cases with ocular syphilis, 86 cases were in men and 6 cases had a past medical history or systemic manifestation of syphilis. HIV was found in only 2 of 70 cases undergoing serum HIV test. The average age was 54.0 years, ranging from 26-85 years. The average percentage of ocular syphilis out from the total syphilis cases was 5.1%, the average titer of serum rapid plasma regain (RPR) at presentation was 1:32, ranging from 1:1-1:512. The most predominant manifestation of ocular syphilis was posterior uveitis, followed by optic neuritis, optic atrophy, panuveitis, retinal vasculitis, and retinitis. The median of BCVA of all 191 eyes was 20/200 (ranging from no light perception to 20/20), and 20/40 (ranging from no light perception to 20/20) at presentation and final follow-up, respectively. Ocular syphilis with active inflammation responded well to penicillin therapy, no matter the initial visual acuity, ocular disease type, or RPR titers, as long as it was diagnosed early and treated properly and promptly. However, cases with optic atrophy, acute retinal necrosis, late diagnosis, permanent disruption, or loss of outer segment of photoreceptors of macular retina on SD-OCT showed poor visual improvement after therapy.
Early diagnosis of ocular syphilis is still challenging in clinical practice and syphilis tests should be routinely performed in patients with uveitis, retinitis, optic neuritis, and optic atrophy.
报告华东某眼中心 6 年病例系列研究中眼部梅毒的人口统计学、临床和实验室特征。
本研究纳入了 2016 年 1 月至 2021 年 12 月期间 131 例（191 只眼）眼部梅毒病例和每年的总梅毒病例数。收集了详细的病历资料，包括全身和眼部病史、全面眼部检查、彩色眼底照相、B 型超声、眼底荧光血管造影（FFA）、谱域光学相干断层扫描（SD-OCT）、血清和脑脊液（CSF）样本的实验室检查，以及疑似视神经炎或视神经萎缩病例的视野检查和眼眶或头颅 MRI。采用 Pearson Chi-square 或 Fisher's exact 检验进行统计学分析。
131 例眼部梅毒患者中，86 例为男性，6 例有梅毒既往病史或全身表现。在 70 例行血清 HIV 检测的病例中仅发现 2 例 HIV 阳性。平均年龄为 54.0 岁，范围为 26-85 岁。眼部梅毒占总梅毒病例的平均百分比为 5.1%，就诊时血清快速血浆反应素（RPR）滴度平均为 1:32，范围为 1:1-1:512。眼部梅毒最常见的表现是后葡萄膜炎，其次是视神经炎、视神经萎缩、全葡萄膜炎、视网膜血管炎和视网膜炎。191 只眼中的中位最佳矫正视力（BCVA）为 20/200（范围从无光感至 20/20），就诊时和最终随访时分别为 20/40（范围从无光感至 20/20）。无论初始视力、眼部疾病类型或 RPR 滴度如何，只要早期诊断并及时、适当治疗，有活动性炎症的梅毒眼病对青霉素治疗反应良好。然而，对于视神经萎缩、急性视网膜坏死、晚期诊断、永久性破坏或黄斑视网膜外节光感受器缺失的病例，SD-OCT 显示治疗后视力改善不佳。
在临床实践中，眼部梅毒的早期诊断仍然具有挑战性，对于葡萄膜炎、视网膜炎、视神经炎和视神经萎缩患者应常规进行梅毒检测。
