Faria Pereira Ana, Gama E Castro Ana, Teixeira-Martins Rita, Coelho-Costa Inês, Torres-Costa Sónia, Silva Marta, Pedrosa Ana Catarina, Araújo Joana, Figueira Luís, Oliveira-Ferreira Cláudia
Department of Ophthalmology, Unidade Local de Saúde de São João, Porto, Portugal.
Unit of Pharmacology and Therapeutics, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal.
Clin Ophthalmol. 2024 Oct 29;18:3053-3069. doi: 10.2147/OPTH.S494585. eCollection 2024.
Syphilis is a re-emerging infectious disease with various systemic manifestations, including ocular involvement, which can lead to significant morbidity if untreated. This study aims to analyze the ocular manifestations of syphilis in patients treated at a Portuguese tertiary center over a 14-year period.
A retrospective review of patients diagnosed with syphilis who presented with ocular symptoms from 2010 to 2023 was conducted. Data collected included demographic information, clinical presentation, ophthalmologic findings, serologic test results, treatment regimens and outcomes.
A total of 47 patients with ocular syphilis were identified. The mean age of the cohort was 45, with a male predominance of 78.7%. The most common ocular manifestations included uveitis (mostly posterior and panuveitis), optic neuritis, acute syphilitic posterior placoid chorioretinitis and vitritis. Best corrected visual acuity (BCVA) at presentation was highly variable, ranging from hand movements to no impairment of visual acuity. At the end of the follow-up period, the majority of the study eyes achieved a BCVA between 0 and 0.1 (p<0,000). Acute syphilitic posterior placoid chorioretinitis was associated with poorer visual outcomes after treatment, indicating its presence is a poor prognosis factor. HIV status, the presence of vitritis, vasculitis and papillitis at presentation, a positive syphilis serology in cerebrospinal fluid and treatment regimen did not appear to have a significant impact on the final BCVA.
Ocular syphilis, though rare, remains a significant cause of visual morbidity. Early recognition and prompt treatment are crucial for preventing permanent vision loss. Regular screening and increased awareness among clinicians are essential to manage this potentially sight-threatening condition effectively. Further research is needed to optimize treatment protocols and improve patient outcomes.
梅毒是一种再度出现的传染病，有多种全身表现，包括眼部受累，若不治疗可导致严重发病。本研究旨在分析葡萄牙一家三级医疗中心14年间治疗的梅毒患者的眼部表现。
对2010年至2023年出现眼部症状并被诊断为梅毒的患者进行回顾性研究。收集的数据包括人口统计学信息、临床表现、眼科检查结果、血清学检测结果、治疗方案及预后。
共确定47例眼部梅毒患者。该队列的平均年龄为45岁，男性占比78.7%。最常见的眼部表现包括葡萄膜炎（主要是后葡萄膜炎和全葡萄膜炎）、视神经炎、急性梅毒性后极部扁平状脉络膜视网膜病变和玻璃体炎。就诊时的最佳矫正视力（BCVA）差异很大，从手动视力到视力无损害。在随访期结束时，大多数研究眼的BCVA在0至0.1之间（p<0.000）。急性梅毒性后极部扁平状脉络膜视网膜病变与治疗后的视力预后较差相关，表明其存在是预后不良的因素。HIV状态、就诊时玻璃体炎、血管炎和视乳头炎的存在、脑脊液梅毒血清学阳性及治疗方案似乎对最终的BCVA没有显著影响。
眼部梅毒虽罕见，但仍是导致视力发病的重要原因。早期识别和及时治疗对于预防永久性视力丧失至关重要。定期筛查和提高临床医生的认识对于有效管理这种潜在的视力威胁状况至关重要。需要进一步研究以优化治疗方案并改善患者预后。
