Clinical characteristics analysis of 114 patients with syphilitic chorioretinitis

Abstract

AIM: To investigate the onset of age, gender, profession, marital characteristics, clinical symptoms, signs, image characteristics of fundus and laser scanning features of syphilitic chorioretinitis.METHODS: Retrospective case series study. A total of 114 patients(138 eyes), 24 of whom were double eyes diagnosed with syphilitic chorioretinitis from January 2006 to January 2023 were included in this study. All of the data were collected from eye examination including the best corrected visual acuity(BCVA), intraocular pressure(IOP), fundus photography, optical coherence tomography(OCT), fundus fluorescein angiography(FFA), indocyanine green angiography(ICGA), visual field, visual evoked response; and blood tests including rapid plasma reagin(RPR)test and treponema pallidum hemagglutination(TPPA)test, tuberculin test, tuberculosis spot test, human immunodeficiency virus, human leukocyte antigen-B27, rheumatism series examination.RESULTS: All patients tested positive for RPR and TPPA, while other laboratory tests were negative, confirming the diagnosis of syphilitic chorioretinopathy. The average age of onset was 44±13.1 years old, with 59 males(51.8%), 55 females(48.2%), 90 monocular cases(78.9%), and 24 binocular cases(21.1%), and there were no significant differences in gender, marriage, or occupation. The main clinical features were visual loss, hyperemia of the optic disc, grayish-yellow opacity of the central retina; FFA mainly showed early dot weak background fluorescence in the peripheral region of the macula, retinal blood vessel fluorescence leakage staining, retinal pigment epithelium(RPE)fluorescence accumulation and optic disc staining or strong fluorescence; ICGA and OCT were mainly manifested by squamous weak fluorescence of the posterior retina; and the manifestations of FFA and ICGA were symmetrical; OCT revealed hyperreflective dots and pinpoint projection of RPE.CONCLUSION: The median age of onset in patients with syphilitic chorioretinitis is 44 years old, and monocular onset is more common. The patient's gender, marriage, and occupation have no significant characteristics. The clinical manifestations mainly include decreased vision, gray white cells in the vitreous body, thickening of the posterior pole retina, and grayish yellow changes. Correctly identifying OCT, FFA, and ICGA features can reduce missed diagnosis and misdiagnosis, and make an early and correct diagnosis and treatment of patients.

Keywords

• syphilis
• chorioretinitis
• clinical features
• fundus angiography
• optical coherence tomography(oct)
• age
• occupation