Contento Robert J, Gupta Neha, Breazzano Mark P
Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY 13210, USA.
Department of Ophthalmology & Visual Sciences, SUNY Upstate Medical University, Syracuse, NY 13210, USA.
Diagnostics (Basel). 2025 Feb 4;15(3):369. doi: 10.3390/diagnostics15030369.
: To investigate the role of multimodal imaging, including ultra-widefield fundus autofluorescence (UWFAF), in diagnosing and monitoring syphilitic chorioretinitis, focusing on the detection of placoid appearance and white dots/spots. We aim to classify syphilitic chorioretinitis as a white dot syndrome, given evident features in the context of recent case reports and previously unavailable multimodal imaging. : This single-institution study was conducted as a consecutive, observational case series. Five eyes from three patients were diagnosed with syphilitic chorioretinitis using multimodal imaging, including ultra-widefield pseudocolor fundus photography and intravenous fluorescein angiography, UWFAF, and swept-source optical coherence tomography, upon laboratory results. : In all five eyes with serologically confirmed syphilitic chorioretinitis, UWFAF revealed hyperautofluorescent white dots and spots scattered in the fundus, a finding minimally apparent with fluorescein angiography. Two eyes did not show evidence of classic placoid lesions. The hyperautofluorescence resolved after standard neurosyphilis treatment with intravenous course of penicillin. : The presence of dots and spots identified through UWFAF may indicate syphilitic chorioretinitis and support its classification as a white dot syndrome. Based on the presence of hyperautofluorescent placoid lesions in some but not all cases with dots and spots, this study highlights the utility of multimodal imaging, including the more recent availability of UWFAF, in diagnosing syphilitic chorioretinitis. Future research is needed to determine whether the dots and spots in syphilitic chorioretinitis represent direct spirochete infiltration or a secondary inflammatory response.
研究包括超广角眼底自发荧光（UWFAF）在内的多模态成像在梅毒脉络膜视网膜炎诊断和监测中的作用，重点关注类脂质性外观和白色小点/斑点的检测。鉴于近期病例报告中的明显特征以及此前无法获得的多模态成像，我们旨在将梅毒脉络膜视网膜炎归类为白点综合征。
本单机构研究作为一个连续的观察性病例系列进行。根据实验室检查结果，对三名患者的五只眼睛进行了多模态成像检查，包括超广角伪彩色眼底照相、静脉荧光素血管造影、UWFAF和扫频光学相干断层扫描，以诊断梅毒脉络膜视网膜炎。
在所有五只血清学确诊为梅毒脉络膜视网膜炎的眼睛中，UWFAF显示眼底散在高自发荧光的白色小点和斑点，荧光素血管造影显示的这一发现不明显。两只眼睛未显示典型类脂质性病变的证据。经静脉注射青霉素进行标准神经梅毒治疗后，高自发荧光消失。
通过UWFAF识别出的小点和斑点的存在可能提示梅毒脉络膜视网膜炎，并支持将其归类为白点综合征。基于在部分但并非所有有小点和斑点的病例中存在高自发荧光类脂质性病变，本研究强调了包括UWFAF在内的多模态成像在诊断梅毒脉络膜视网膜炎中的作用。未来需要进一步研究以确定梅毒脉络膜视网膜炎中的小点和斑点是代表螺旋体直接浸润还是继发炎症反应。
