ABSTRACT
Acquired syphilis uveitis,due to lack of the characteristic features,presents with various types.The most common type is posterior uveitis and panuveitis,including chorioretinitis,retinal vasculitis,optic nerve retinitis.The diagnosis and assessment of response to treatment depends mainly on the serological diagnostic tests,including nontreponemal and treponemal test.Acquired syphilis uveitis often presents with manifestations similar to various types of uveitis,especially to autoimmune uveitis and other infectious uveitis,so differential diagnosis is important.The gold standard treatment for active syphilitic uveitis is penicillin G,or doxycycline if patient is allergy to penicillin.Clinically misdiagnosis and delayed treatment may result in irreversible visual impairment and severe systemic and eye complications.However such timely treatment always has a good prognosis.
ABSTRACT
Objective To observe the prognosis and correlated factors of cystoid macular edema (CME) secondary to uveitis.Methods A retrospective,noncomparative case series study.The clinical data of 31 uveitis patients with CME were collected from Uveitis & Ocular Immunology Service of Tianjin Medical University Eye Hospital from August 2011 to December 2015.Pre-treatment and post-treatment data were collected,including details of best-corrected visual acuity (BCVA),central macular thickness (CMT),other macular complications,and intraocular pressure (IOP).Results Twenty-seven patients (36 eyes) were analyzed.At the 1 st month after treatment,complete resolution of CME was achieved in 14 eyes (38.9％),BCVA increased from (0.66 ±0.36) LogMAR at baseline to (0.40 ±0.31) LogMAR (P ＜0.001),and CMT decreased from (469.0 ± 99.1) μm at baseline to (368.7 ± 85.9) μm (P ＜ 0.001).At the 3rd month after treatment,complete resolution of CME was found in 19 eyes (52.8％),no significant difference was found in CMT(323.9 ±60.0) μm or BCVA(0.37 ±0.32)LogMAR compared with the 1 st month after treatment (P ＞ 0.05),significant difference was found in CMT(P ＜0.001) or BCVA(P ＜0.001) before the start of treatment.At the 6th month or more after treatment,complete resolution of CME occurred in 25 eyes (69.4％),BCVA(0.32 ± 0.28)LogMAR was significant difference compared with that before the start of treatment(P ＜ 0.05),at the 1st month(P ＜ 0.05),at the 3rd month (P ＜ 0.05).CMT (294.2 ± 81.2) μm was significant difference compared with that before the start of treatment(P ＜0.001),at the 1st month(P ＜0.001),however,no significant difference was compared with that at the 3rd month (P ＞ 0.05).At the 6th month or more after treatment,11 eyes (30.6％) had a persistent macular edema,complicated with macular epiretinal membrane,no significant correlation between the reduction of CMT(185.0 ± 114.2) μm and the improvement of BCVA (0.29 ± 0.21) LogMAR was found (r =0.322,P=0.052),while the improvement of BCVA(0.29 ± 0.21)LogMAR was negatively associated with the duration of CME(8.4 ±9.8)months(r =-0.395,P =0.015).Conclusion Current therapies are effective in curing most of the CME secondary to uveitis.The duration of CME,is correlated with poor final visual acuity,the presence of ERM is an important factor associated with regression of CME.
ABSTRACT
Objective To summarize and describe clinical features and treatment outcome of syphilitic scleritis.Methods A retrospective study was conducted in patients diagnosed as syphilitic scleritis from 2011 to 2016 in our hospital.Clinical characteristics and prognosis were evaluated.Results Seven patients (7 eyes) were diagnosed as syphilitic scleritis by clinical and serological examinations.All patients were unaware that they had syphilis infection before visit.The ocular manifestation was the only clinical fmdings in three patients.Both treponema pallidum particle agglutination and rapid plasma regain were positive.Meanwhile,the scleritis infection was excluded,tests for human immunodeficiency virus (HIV) were negative.Syphilitic scleritis was unilateral in all patients,and the duration was from one week to two years.Initial symptoms were varied in degree of ocular redness,pain and visual impairment.Two patients presented with anterior episcleritis,nodular anterior scleritis was found in three patients,one patient showed diffuse anterior scleritis,and one patient presented with diffuse episcleritis combined with acute syphilitic posterior placoid chorioretinitis.All patients were treated with penicillin G,and inflammation resolved quickly after treatment.Conelusion Syphilitic scleritis is rare and ease to be misdiagnosed,various types of anterior scleritis is the main manifestation.Syphilitic serologic test should be performed for the suspected cases.The prognosis is well with anti-syphilis therapy.