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SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY FINDINGS IN PATIENTS WITH ACUTE SYPHILITIC POSTERIOR PLACOID CHORIORETINOPATHY

Pichi, Francesco MD*; Ciardella, Antonio P. MD; Cunningham, Emmett T. Jr MD, PhD, MPH‡,§,¶; Morara, Mariachiara MD; Veronese, Chiara MD; Jumper, J. Michael MD‡,¶; Albini, Thomas A. MD**; Sarraf, David MD††; McCannel, Colin MD††; Voleti, Vinod MD††; Choudhry, Netan MD, FRCSC(C)‡‡; Bertelli, Enrico MD§§; Giuliari, Gian Paolo MD¶¶; Souied, Eric MD, PhD***; Amer, Radgonde MD†††; Regine, Federico MD‡‡‡; Ricci, Federico MD§§§; Neri, Piergiorgio MD, PhD¶¶¶; Nucci, Paolo MD*

doi: 10.1097/IAE.0b013e3182993f11
Original Study

Purpose: To describe the appearance of acute syphilitic posterior placoid chorioretinitis, a rare ocular manifestation of syphilis, on spectral domain optical coherence tomography (SD OCT) both before and after treatment.

Methods: Ophthalmic examination and imaging studies of 30 eyes of 19 confirmed cases were analyzed both at the time of presentation and at each follow-up visit. Patients with SD OCT and fluorescein angiography at the time of presentation, and at least three documented follow-up visits after initiation of therapy, were included in the study. Standard treatment of neurosyphilis was given to each patient, including 4 million units of penicillin G administered intravenously every 4 hours for 14 days.

Results: Fundus examination and imaging studies were consistent with previous reports and confirmed the diagnosis of acute syphilitic posterior placoid chorioretinitis. In 13 eyes (43.3%), baseline SD OCT scans were performed within 1 to 2 days of presentation and revealed a small amount of subretinal fluid, disruption of the inner segment/outer segment junction, and hyperreflective thickening of the retinal pigment epithelium (RPE). All 30 eyes were again scanned between Days 7 and 9 after presentation and revealed loss of the inner segment/outer segment and OS/RPE bands, and irregular hyperreflectivity of the RPE with prominent nodular elevations but without subretinal fluid. Early disruption of the external limiting membrane and punctate choroidal hyperreflectivity were seen in 1 of the 30 eyes (3.3%) and 14 of the 30 eyes (46.6%), respectively. Vision improved and the outer retinal abnormalities normalized in 28 of the 30 eyes (93.3%) after the treatment of neurosyphilis. The external limiting membrane, inner segment/outer segment band, and/or linear outer segment/RPE junction remained substantially abnormal despite treatment in 2 eyes left with 20/200 vision.

Conclusion: Patients with acute syphilitic posterior placoid chorioretinitis show characteristic outer retinal abnormalities on SD OCT imaging, including disruption of the inner segment/outer segment band, nodular thickening of the RPE with loss of the linear outer segment/RPE junction, and, in some cases, loss of the external limiting membrane, accumulation of subretinal fluid, and punctate hyperreflectivity in the choroid. Vision improved and these abnormalities reversed after treatment of neurosyphilis in most of the patients. Persistently, poor vision despite treatment was associated with long-term loss or disruption of outer retinal anatomy on SD OCT.

Patients with acute syphilitic posterior placoid chorioretinitis show characteristic outer retinal abnormalities on spectral domain optical coherence tomography imaging, including disruption of the inner segment/outer segment band, nodular thickening of the retinal pigment epithelium with loss of the linear outer segment/retinal pigment epithelium junction, and, in some cases, loss of the external limiting membrane, accumulation of subretinal fluid, and punctate hyperreflectivity in the choroid. Vision improved and these abnormalities reversed after treatment of neurosyphilis in most of the patients. Persistently, poor vision despite treatment was associated with long-term loss or disruption of outer retinal anatomy on spectral domain optical coherence tomography.

*San Giuseppe Hospital, University Eye Clinic, Milan, Italy;

Ophthalmology Unit, Policlinico Sant’Orsola-Malpighi, Bologna, Italy;

Department of Ophthalmology, California Pacific Medical Center, San Francisco, California;

§Department of Ophthalmology, Stanford University School of Medicine, Stanford, California;

West Coast Retina Medical Group, San Francisco, California;

**Bascom Palmer Eye Institute, University of Miami-Miller School of Medicine, Miami, Florida;

††Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles, California;

‡‡Herzig Eye Institute, Toronto, Canada;

§§Department of Ophthalmology, Bolzano Central Hospital, Bolzano, Italy;

¶¶Center of Ophthalmic Surgery, Caracas, Venezuela;

***Department of Ophthalmology, Domingo Luciani Hospital, Caracas, Venezuela;

†††Ophthalmology Service, Intercommunal Hospital of Créteil, Creteil, France;

‡‡‡Uveitis and Ocular Immunology Service, Hadassah University Hospital, Jerusalem, Israel;

§§§Retinal Pathologies Unit, University of Rome Tor Vergata, Tor Vergata Foundation, Rome, Italy; and

¶¶¶The Ocular Immunology Service, The Eye Clinic, Polytechnic University of Marche, Ancona, Italy.

Reprint requests: Francesco Pichi, MD, San Giuseppe Hospital, University Eye Clinic, via San Vittore 12, Milan 20123, Italy; e-mail: ilmiticopicchio@gmail.com

None of the authors have any financial/conflicting interests to disclose.

© 2014 by Ophthalmic Communications Society, Inc.