Optom Vis Sci. 2022 Oct 1;99(10):774-780. doi: 10.1097/OPX.0000000000001942. Epub 2022 Sep 6.
Acute syphilitic posterior placoid chorioretinitis (ASPPC) is a rare clinical presentation of ocular syphilis. The worldwide incidence of syphilis has recently increased. Clinicians should be familiar with the distinct appearance and imaging findings of ASPPC and promptly initiate antibiotic treatment to limit functional vision loss and systemic complications of neurosyphilis.
This case demonstrates the utility of optical coherence tomography angiography (OCT-A) imaging to further understand the pathophysiology and visual prognosis of ASPPC.
A 75-year-old man presented with 7 days of decreased vision in his left eye. His visual acuity was 20/20 in the right eye and 20/200 in the left eye. Fundus examination revealed placoid lesions in the superior and inferotemporal aspects of the posterior pole in the right eye and a large placoid macular lesion in the left eye. Optical coherence tomography imaging revealed disruption and loss of the ellipsoid zone and external limiting membrane, nodular elevations on the retinal pigment epithelium, and choroidal hyperreflective punctate lesions in the left eye. Optical coherence tomography angiography displayed choriocapillaris perfusion flow voids greater in the left eye than in the right eye. Two months after penicillin treatment, the placoid lesions resolved in both eyes with an improvement in outer retinal structural abnormalities on optical coherence tomography imaging and visual acuity to 20/25 in the left eye. Eleven months after presentation, the OCT-A choriocapillaris flow voids had improved without complete restoration.
The flow voids seen on OCT-A imaging in this case of ASPPC suggest a possible inflammatory process with a primary location in the choriocapillaris.
急性梅毒性后浆性脉络膜视网膜炎（ASPPC）是眼部梅毒的一种罕见临床表现。最近，梅毒的全球发病率有所上升。临床医生应熟悉 ASPPC 的独特表现和影像学特征，并及时启动抗生素治疗，以限制功能视力丧失和神经梅毒的全身并发症。
本病例展示了光相干断层扫描血管造影（OCT-A）成像在进一步了解 ASPPC 的病理生理学和视觉预后方面的效用。
一名 75 岁男性因左眼视力下降 7 天就诊。他右眼视力为 20/20，左眼视力为 20/200。眼底检查显示右眼后极上、下象限有盘状病变，左眼有大的盘状黄斑病变。光学相干断层扫描成像显示左眼的椭圆体带和外界膜中断和丢失，视网膜色素上皮的结节性隆起，脉络膜高反射点状病变。光学相干断层扫描血管造影显示左眼脉络膜毛细血管灌注血流缺失较右眼更明显。青霉素治疗 2 个月后，双眼盘状病变消退，左眼外视网膜结构异常在光学相干断层扫描成像上得到改善，视力提高至 20/25。发病后 11 个月，OCT-A 脉络膜毛细血管血流缺失得到改善，但未完全恢复。
本例 ASPPC 中 OCT-A 成像上的血流缺失提示可能存在以脉络膜毛细血管为主要部位的炎症过程。
