Harvey Justin, Lee Ivan J, Lee Chang Sup, Hinkle David
Department of Ophthalmology, West Virginia University School of Medicine, 1 Medical Center Drive, Box 9193, Morgantown, WV, 26506, USA.
Department of Ophthalmology, Tulane University School of Medicine, New Orleans, LA, USA.
Int Ophthalmol. 2023 Dec;43(12):4419-4426. doi: 10.1007/s10792-023-02759-2. Epub 2023 Sep 29.
The purpose of the study was to evaluate the incidence of ocular syphilis as well as diagnostic parameters, comorbidities, and visual outcomes over a 10-year time period in West Virginia.
A retrospective chart review included 25 eyes of 17 patients with ocular syphilis between 2010 and 2020.
The incidence of systemic syphilis at a large tertiary referral center has increased from 27 cases in 2010 to 105 cases in 2020. Seventeen patients were identified with ocular syphilis. Bilaterality was present in 47.1% of cases. In this study, 70.6% of patients were male and 29.4% were female. The median age of presentation was 40.2 years (range 21-63). Panuveitis was the most common (60.0%) followed by isolated anterior uveitis (16.0%), chorioretinitis (12.0%), inner retinitis (4.0%), and papillitis (8.0%). Forty percent of patients had visual acuity worse than 20/400 on presentation. Post-treatment visual acuity improved in all patients. Rapid plasma reagin (RPR) and Treponema pallidum particle agglutination (TP-PA) tests were positive in 84.6% and 100% of cases, respectively. CSF venereal disease research laboratory (VDRL) was positive in 36.4%, CSF pleocytosis was present in 72.7%, and elevated CSF protein was observed in 81.8%. Human immunodeficiency virus (HIV) co-infection was present in 31.3%. A majority of patients experienced maculopapular rash and/or history of genital chancre. The anatomic classification of presenting uveitis (anterior, intermediate, posterior, and panuveitis) did not correlate with clinical variables including age, gender, HIV status, serologic test, presence of rash, or year of diagnosis (p > 0.05).
Ocular syphilis is becoming increasingly prevalent and can present with a variety of ocular findings; therefore, it should be considered in the differential diagnosis for patients with ocular inflammation. Visual prognosis is excellent with timely diagnosis and treatment.
本研究旨在评估西弗吉尼亚州10年间眼梅毒的发病率、诊断参数、合并症及视力转归情况。
对2010年至2020年间17例眼梅毒患者的25只眼进行回顾性病历审查。
一家大型三级转诊中心的系统性梅毒发病率从2010年的27例增至2020年的105例。确诊17例眼梅毒患者。47.1%的病例为双侧患病。本研究中，70.6%的患者为男性，29.4%为女性。就诊时的中位年龄为40.2岁（范围21 - 63岁）。全葡萄膜炎最为常见（60.0%），其次为单纯性前葡萄膜炎（16.0%）、脉络膜视网膜炎（12.0%）、视网膜内层炎（4.0%）和视乳头炎（8.0%）。40%的患者就诊时视力低于20/400。所有患者治疗后的视力均有改善。快速血浆反应素（RPR）试验和梅毒螺旋体颗粒凝集试验（TP - PA）的阳性率分别为84.6%和100%。脑脊液性病研究实验室（VDRL）试验阳性率为36.4%，脑脊液细胞增多症发生率为72.7%，脑脊液蛋白升高发生率为81.8%。合并人类免疫缺陷病毒（HIV）感染率为31.3%。大多数患者出现斑丘疹和/或有生殖器溃疡病史。所呈现的葡萄膜炎的解剖学分类（前葡萄膜炎、中间葡萄膜炎、后葡萄膜炎和全葡萄膜炎）与包括年龄、性别、HIV感染状况、血清学检查、皮疹情况或诊断年份在内的临床变量均无相关性（p＞0.05）。
眼梅毒正日益普遍，可表现为多种眼部表现；因此，对于眼部炎症患者的鉴别诊断应考虑该病。及时诊断和治疗，视力预后良好。
