Spectral-Domain Optical Coherence Tomography Features of Acute Syphilitic Posterior Placoid Chorioretinitis: The Role of Autoimmune Response in Pathogenesis

Brito, Pedro Quelhas; Penas, Susana; Carneiro, Ângela; Palmares, Jorge; Reis, Fernando Falcão

doi:10.1159/000324086

Cited by 50 publications

(47 citation statements)

References 12 publications

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“…This anatomical restoration was related to visual acuity improvement that varied from 20/20 to 20/60 (mean, 20/30) at the last follow-up (1 month). The disappearance of these outer retinal features and nearly complete normalization of visual acuity following the standard syphilis therapy has been described in other previous reports [13, 14]. In our case, there would be a complete disappearance of the outer retinal lesions and a total visual acuity return to normal levels whether the follow-up was longer than 1 month.…”

Section: Discussionsupporting

confidence: 82%

“…In addition, hyperreflective pinpoint lesions in the choroid have been previously described in the literature [13]. Although subretinal fluid (SRF) and external ELM disruption have been observed on OCT scans of syphilis patients [12–14, 17], our case did not show similar changes. As SRF is a very early feature of APPC and its incidence in ASPPC varies between 11.8 and 43.3% [12, 13], the lack of SRF in our case may be due to the later performance of SD-OCT. En-face scans at the level of RPE and EZ demonstrated several roundish hyperreflective lesions that appeared confluent in the parafoveal area and corresponded to the hyperreflective nodularity of the RPE seen on SD-OCT.…”

Section: Discussionmentioning

confidence: 39%

“…Fluorescein (FA) and indocyanine green (ICG) angiography usually demonstrate early central hypo or hyperfluorescence followed by late hyperfluorescence (staining) [11, 12]. On spectral-domain optical coherence tomography (SD-OCT), ASPPC may lead to outer retinal changes such as disruption and loss of both the ellipsoid zone (EZ) and external limiting membrane (ELM), nodular thickening of the RPE, and accumulation of subretinal fluid [13, 14]. In this case report, we correlate both the en-face and SD-OCT findings of the outer retina along with the clinical evolution of one patient diagnosed with ASPPC.…”

Section: Resultsmentioning

confidence: 99%

“…Similar SD-OCT outer retinal changes were previously described. Brito et al [14] reported an acute disruption of the outer retinal bands, irregular hyperreflectivity with nodular elevation of the RPE, and punctate hyperreflectivity in the choroid. Pichi et al [13] also observed an irregular hyperreflectivity with nodular elevations at the junction of the photoreceptors and the RPE associated with segmental loss of the EZ.…”

Section: Discussionmentioning

confidence: 99%

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Multimodal imaging analyses of hyperreflective dot-like lesions in acute syphilitic posterior placoid chorioretinopathy

Lima

Andrade

Vianello

et al. 2017

J Ophthal Inflamm Infect

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BackgroundRetrospective review of one acute syphilitic posterior placoid chorioretinitis (ASPPC) case with serological evidence of syphilis who had ocular signs and symptoms not attributable to other diseases. Enface and spectral-domain optical coherence tomographySD-OCT were analyzed at the time of presentation and at 1-month visit following initiation of treatment. The study patient underwent standard treatment for neurosyphilis.ResultsOphthalmic examination and imaging studies were consistent with the diagnosis of ASPPC. The patient age was 33 year-old and the baseline visual acuity was 20/400 and 20/80 in the right and left eyes, respectively. At presentation, SD-OCT scans showed disruption and loss of the ellipsoid zone (EZ), small nodular elevations on retinal pigment epithelium (RPE) and punctate hyperreflectivity in the choroid. Enface OCT at the level of RPE and EZ demonstrated multiple hyperreflective dot-like lesions simmetrically distributed within the macular area. These dot-like lesions corresponded to the small nodular elevations on RPE and to disruption/loss of EZ observed with SD-OCT. One month after neurosyphilis therapy, the visual acuity improved and the outer retinal changes partially reversed in both eyes.ConclusionsWe report the outer retinal findings and its correlation using both en-face and SD-OCT in a patient with ASPPC. En-face OCT imaging provides a more precise outer retinal layers analyses allowing a better understanding of the ASPPC pathophysiology.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 39%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Multimodal imaging analyses of hyperreflective dot-like lesions in acute syphilitic posterior placoid chorioretinopathy

Lima

Andrade

Vianello

et al. 2017

J Ophthal Inflamm Infect

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“…After treatment, there was partial return of the normal choroidal signal, and return of signal in these 2 retinal layers with vision improvement to 20/25. 20 The authors believe these reversible findings point to physiological impairment of the neuroretina as opposed to anatomic injury. ' …”

Section: ' Optical Coherence Tomography (Oct) Findingsmentioning

confidence: 99%

Imaging Syphilitic Uveitis

Jumper

Randhawa

2012

International Ophthalmology Clinics

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Syphilis remains an important cause of uveitis. After reaching a peak annual incidence in the United States of 20.3 cases per 100,000 population in 1990, rates of primary and secondary syphilis declined over the ensuing decade to a record low of 2.1 cases per 100,000 population in 2000, an 89.7% decrease. Despite efforts by the Centers for Disease Control and Prevention to eradicate syphilis, there has been an increase in primary and secondary syphilis rates over the past decade, reaching 4.5 cases per 100,000 population in 2010. 1 In recent years, younger men and men having sex with men have accounted for an increasing number of syphilis cases in the United States. 2 The incidence of syphilis has increased in other countries over the past decade as well. 3,4 Retrospective reviews from large centers have shown that syphilis is the cause of 1.1% to 4.3% of uveitis referrals. 5-7 Although rare, the protean ocular manifestations of syphilis, the potential systemic consequences of untreated syphilis, and the ability to render a long-term cure with antibiotic treatment increase the importance to appropriately test our patients for this disease.The diagnosis of ocular syphilis remains challenging as it can mimic other infectious and noninfectious conditions and the causative organism, Treponema pallidum is not easily recovered in culture. Serology is the method of choice for diagnosing syphilis. Both nontreponemal (eg, venereal disease research laboratory, rapid plasma reagin) and treponemal (eg, T. pallidum particle agglutination, fluorescent treponemal antibody) assays are used. Nontreponemal assays detect antibodies to cardiolipin, are not specific to T. pallidum, and seroconvert to negative after treatment. Treponemal assays detect antibodies to Treponema species and remain reactive for years after adequate therapy. Although

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