Jones Nicholas, Agorogiannis Eleftherios
School of Biological Sciences, University of Manchester, Manchester, UK.
Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
Ocul Immunol Inflamm. 2025 Oct;33(8):1757-1767. doi: 10.1080/09273948.2025.2511129. Epub 2025 Jun 18.
To investigate all published reports of acute syphilitic posterior placoid chorioretinitis (ASPPC) and to analyse demographic, clinical and management features to clarify trends in presentation, diagnosis and outcome.
A comprehensive review of literature relating to ASPPC including examples within published series of ocular syphilis, case series limited to ASPPC and case reports.
A total of 128 publications included 286 patients with 387 eyes affected by ASPPC. This is increasing in frequency and since 2020 accounts for 26% of ocular syphilis in case series; it appears most common in countries where the predominant Treponema pallidum subclade is SS14 Omega. Visual symptoms were the first in 81%. The mean age at onset was 47.0 yrs (range 23-81), 84% were male and these were more likely to be men who had sex with men (MSM)( = 0.001). Risk was not increased by HIV positivity. Recovery to LogMAR 0.3 or better was achieved in 85%.
Men are particularly affected by ASPPC, especially MSM. It is associated with otosyphilis. Optic nerve involvement is less common in ASPPC, compared to other forms of ocular syphilis. Visual outcomes were very good unless treatment onset was delayed and were equally good for HIV+ and HIV- patients; IV penicillin, IM penicillin and IV ceftriaxone were equally effective. Data quality on systemic steroid usage was too poor to permit analysis. The aetiology of ASPPC remains unknown but geographical disparity supports the possibility of an association between ASPPC and particular treponemal subclade(s).
调查所有已发表的急性梅毒性后极部扁平状脉络膜视网膜炎（ASPPC）报告，并分析人口统计学、临床和管理特征，以阐明其临床表现、诊断和预后趋势。
全面回顾与ASPPC相关的文献，包括已发表的眼部梅毒系列病例中的实例、仅限于ASPPC的病例系列以及病例报告。
共有128篇出版物，其中包括286例患者的387只眼睛受ASPPC影响。其发病率呈上升趋势，自2020年以来在病例系列中占眼部梅毒的26%；在苍白密螺旋体主要亚型为SS14 Omega的国家似乎最为常见。81%的患者首发症状为视觉症状。发病的平均年龄为47.0岁（范围23 - 81岁），84%为男性，且这些男性更有可能是男男性行为者（MSM）（P = 0.001）。HIV阳性并不会增加患病风险。85%的患者视力恢复至LogMAR 0.3或更好。
男性尤其易患ASPPC，尤其是男男性行为者。它与耳梅毒有关。与其他形式的眼部梅毒相比，ASPPC中视神经受累较少见。除非治疗延迟，视觉预后非常好，HIV阳性和HIV阴性患者的预后同样良好；静脉注射青霉素、肌肉注射青霉素和静脉注射头孢曲松同样有效。关于全身使用类固醇的数据质量太差，无法进行分析。ASPPC的病因仍然未知，但地域差异支持ASPPC与特定梅毒亚种之间存在关联的可能性。
