梅毒性葡萄膜炎3例

目的：评估梅毒性葡萄膜炎患者的临床表现和视力. 方法：梅毒性葡萄膜炎患者3例在USM医院接受治疗. 结果：患者3例被诊断为继发性梅毒性葡萄膜炎,这3例患者患病之前均不知道患有梅毒,但他们有明确的乱交史.并且每个月都伴有逐步的视力下降.其中两人伴有发热、跟痛、眼前悬浮物.视力从6/12到手动.所有患者均出现前葡萄膜炎,玻璃体炎和视神经炎.第一例患者出现了多灶性脉络膜视网膜炎,并伴有渗出性视网膜脱离.第二例患者出现渗出性视网膜脱离,而第三例患者仅出现了脉络膜视网膜炎.所有患者每周注射苄青霉素2.4MU,共4wk,其中2例患者口服多西霉素200mg 2次/d,共3mo.治疗效果良好,其中2例患者有显著的视力上升,分别从6/120到6/21和6/12到6/6.其中较严重的1例患者出现逆转录酶为阳性. 结论：眼梅毒作为非肉芽肿性的炎症与渗出性视网膜脱离有关.治疗后虽然视力恢复比较缓慢,但普遍有良好的效果.     

梅毒性脉络膜视网膜炎一例

梅毒是一种性传播疾病,其发病率近年来有逐渐上升的趋势.梅毒的基本病理改变是血管内膜炎和血管周围炎,有3个典型的临床阶段：一期梅毒、二期梅毒和三期梅毒,这3个阶段都可以有不同的眼部表现,如结膜炎、间质性角膜炎、前葡萄膜炎、中间葡萄膜炎或后葡萄膜炎、视神经炎、视神经视网膜炎、视网膜血管炎、脉络膜视网膜炎和视网膜脱离等.本次,我们将一例隐性梅毒并发梅毒性脉络膜视网膜炎患者报道如下.     

梅毒性眼病的临床分析

目的：探讨以眼后节表现为主的梅毒性眼病的临床特点。

方法：回顾性病例研究。回顾性分析2007-01/2012-01本院收治的首诊于眼科的梅毒性眼病13例23眼,分析其临床表现、治疗方法、预后等。13例患者按神经梅毒除1例因青霉素过敏予静滴头孢曲松治疗,其余全部予静滴青霉素治疗。

结果：患者13例中,9例17眼患者表现为脉络膜视网膜炎,2例3眼患者表现为视神经视网膜炎,1例1眼患者表现为视神经炎,1例2眼患者表现为渗出性视网膜脱离。抗梅毒治疗后,所有炎症消退,12例22眼患者视力提高,平均视力0.56±0.23。患者RPR滴度下降4倍,平均1：16.6。

结论：梅毒性眼病表现多样,容易漏诊、误诊,临床上应提高警惕,及早发现,及早治疗。     

前后节联合手术治疗复杂性葡萄膜炎的临床疗效

目的: 探讨前后节联合手术治疗眼后段组织受累的复杂性葡萄膜炎患者的初步临床疗效。方法: 回顾性临床研究。收集2018年5月至2021年1月在首都医科大学附属北京朝阳医院眼科接受前后节联合手术的葡萄膜炎合并白内障患者33例(33眼)的临床资料。根据致病原因分为:感染组16例(16眼), 其中巨细胞病毒性脉络膜视网膜炎4眼, 疱疹病毒性葡萄膜炎3眼, 弓形虫性葡萄膜炎2眼, 急性视网膜坏死1眼, 细菌或真菌性眼内炎6眼;非感染组17例(17眼), 其中特发性葡萄膜炎12眼, 眼内淋巴瘤1眼, 虹膜异色性睫状体炎2眼, 幼年特发性关节炎性葡萄膜炎2眼。采用Wilcoxon符号秩检验分析所有患者手术前后的视力、眼压、房水闪辉指数变化以及组间术后视力差异。采用卡方检验比较不同组间术中植入人工晶状体(IOL)及硅油填充比例的差异。结果: 全部患者的术前LogMAR最佳矫正视力(BCVA)为2.40(1.50, 2.70), 术后BCVA为1.70(0.55, 2.70), 术后视力明显提高(Z=-2.61, P=0.009)。术后, 感染组LogMAR BCVA为2.25(2.10, 2.93),...     

内因性葡萄膜炎与血清抗结核抗体水平

目的　应用酶联免疫吸附法检测血清中抗结核抗体 ,以期探讨内因性葡萄膜炎与抗结核抗体水平的关系。方法　收集各种类型的葡萄膜炎病人 197例 ,并分别取血进行血清中抗结核抗体测定。结果　收集各类葡萄膜炎病人 197例 ,其中男性 112例 ,女性 85例 ;平均年龄为 32 .2± 11.8岁。其中右眼受累 10 9眼 ,左眼受累 88眼。应用酶联免疫吸附法检测 197例葡萄膜炎病人血清中抗结核抗体 ,阳性 16份 ,阳性率为 8.1%。其中视网膜静脉周围炎患者的阳性率最高 (17.9% ) ,其次为中心性渗出性视网膜脉络膜病变 (12 .1% ) ,其他类型的葡萄膜炎病人的感染率基本相近。经统计学检验 ,血清中抗结核抗体阳性率与视网膜静脉周围炎和中心性渗出性视网膜脉络膜病变有关。结论　血清中抗结核抗体阳性率与视网膜静脉周围炎和中心性渗出性视网膜脉络膜病变有关。     

眼弓形体病晚期并发症—脉络膜新生血管膜

眼弓形体病常表现为前色素膜炎、视网膜脉络膜炎、玻璃体炎等。作者报告3例视力突然障碍是由静止性视网膜脉络膜疤痕附近的脉络膜新生血管膜所致的黄斑脱离而引起。其中1例新生血管膜成功地用氩激光光凝治疗。例1:13岁女孩,以往视力6/6,后降至6/7.5,视网膜有炎症。Sabin-Feldman染色试验阳性,效价1∶128,证实了临床疑为弓形体性视网膜脉络膜炎,用乙嘧啶(Pyrimethamine)、磺胺嘧啶及全身类固醇治疗,炎症静止而停药。右中心凹下方留有视网膜脉络膜疤痕。1年后发现疤痕附近有青灰色脉络膜新生血管膜引起黄斑部浆液性脱离。荧光血管造影显示新生血管膜位于中心凹后方而未予治疗。又1年后视力6/15。例2:53岁女患者,12岁开始双侧黄斑部有脉络膜视网膜疤痕,诊断为先天性弓形体病。视     

孤立性脉络膜血管瘤的临床疗效观察

目的：探讨孤立性脉络膜血管瘤的治疗疗效。方法：回顾性分析24例孤立性脉络膜血管瘤的临床资料。24例中，男17人，女7人，平均年龄43．29岁。全部患者均存在渗出性视网膜脱离，其中，6眼视网膜脱离为移动性。患者首选激光治疗，激光治疗无效并存在移动性视网膜脱离者行巩膜外冷冻治疗。患者平均随访21．17月。结果：无移动性视网膜脱离的18眼，激光治疗后视力稳定或提高者占94．5％。瘤体表面仍有少量液体残存的共有3眼(12．5％)均为黄斑中心下的血管瘤。有移动性视网膜脱离的6眼最终均行冷冻治疗，冷冻术后周边液体吸收，5例视力下降。结论：位于黄斑下的及伴有移动性视网膜下液的脉络膜血管瘤预后差。     

玻璃体切除术治疗合并脉络膜脱离的孔源性视网膜脱离18例

目的：探讨玻璃体切除术治疗孔源性视网膜脱离并发脉络膜脱离的方法和疗效。方法：18例18眼并发脉络膜脱离的孔源性视网膜脱离,行玻璃体切除术治疗,术后观察视力、视网膜复位情况及手术并发症等,随访2～6(平均3．3)mo。结果：在18眼中13眼(72％)术后视网膜复位,大部分视力均有不同程度的提高;5眼视网膜未复位,其中3眼经再手术后复位,2眼眼球萎缩,未再手术。手术并发症主要有术后葡萄膜炎、玻璃体积血、术后高眼压等。结论：及时的玻璃体手术治疗合并脉络膜脱离的孔源性视网膜脱离,大多数视网膜能够获得复位,部分恢复视功能。     

梅毒性葡萄膜炎临床分析

目的 探讨梅毒性葡萄膜炎的临床特征.方法 经临床及检验确诊为梅毒性葡萄膜炎患者29例,分析总结其临床特征.结果 29例患者中15例为双眼发病,男19例,女10例,平均年龄41岁.以眼红痛视力下降等为主诉,诊断35只眼梅毒性脉络膜炎,其中29只眼同时诊断梅毒性视网膜血管炎,12只眼梅毒性后葡萄膜炎继发视网膜色素变性;2只眼继发性视网膜色素变性;2只眼梅毒性前葡萄膜炎;5只眼梅毒性全葡萄膜炎.30只眼发病1个月内来就诊,治疗后3个月内视力明显提高,眼底病变完全消退.12只眼距发病3个月内来就诊,之前均被外院误诊,并接受大剂量糖皮质激素治疗,治疗后眼底病变消退6个月到2年不等.结论 梅毒性葡萄膜炎以性脉络膜炎最常见,早期诊断及时治疗预后良好.     

57例经玻璃体手术治疗的渗出性视网膜脱离临床分析

目的 总结玻璃体手术治疗的渗出性视网膜脱离患者的病因、手术指征及术后效果.设计 回顾性病例系列.研究对象 57例经玻璃体手术治疗的渗出性视网膜脱离患者.方法 回顾性分析相应的临床资料.主要指标 病因、手术指征及术后效果.结果 57例(62眼)渗出性视网膜脱离中Coats病23例(45.2%),为引起渗出性视网膜脱离的主要病因;其次为家族性渗出性玻璃体视网膜病变8例(12.9%)、葡萄膜炎7例(11.3%)、视网膜血管瘤7例(11.3%)、泡性视网膜脱离6例(9.7%)、眼内炎4例(6.5%)和视乳头小凹2例(3.2%).严重的渗出性视网膜脱离及并发增生性病变是进行玻璃体手术的指征.术后短期大部分患者可获有用视力;随访6个月以上者64.9%,渗出性视网膜脱离复发率为5.4%,大部分患者仍能保留有用的视力.结论 Coats病是引起渗出性视网膜脱离中需要采取玻璃体手术治疗的最主要原因.当渗出性视网膜脱离引起增生性病变、玻璃体积血或病变累及黄斑时是采取玻璃体手术的主要指征.手术可使大部分患者获得有用视力.(眼科,2008,17:52-55)     

Syphilitic uveitis: report of 3 cases

AIM: To evaluate the clinical manifestations and visual outcome of syphilitic uveitis patients. METHODS: Case series of three patients with syphilitic uveitis who were managed in Hospital USM. RESULTS: Three patients were diagnosed to have uveitis secondary to Syphilis. All three patients were not known to have syphilis prior to presentation but have positive history of sexual promiscuity. All patients presented with progressive blurring of vision for average of one-month duration. Two of them have association with fever, ocular pain and floaters. Visual acuity at presentation ranges from 6/12 to hand movement. Mild anterior uveitis (non-granulomatous), vitritis and papillitis were presence in all the patients. First patient has multifocal chorioretinitis with exudative retinal detachment. The second patient presented with exudative retinal detachment while the third patient has chorioretinitis only. All the patients were treated with intramuscular benzyl-penicillin 2.4 MU weekly for 4 weeks and two of them received oral doxycycline 200mg twice daily for 3 months. The uveitis responded well to the treatment and two of them showed dramatic visual improvement from 6/120 to 6/21 and 6/12 to 6/6. The one with worse outcome was confirmed to have positive retroviral. CONCLUSION: Ocular syphilis presented here as non- granulomatous inflammation associated with exudative retinal detachment. Final visual outcome is generally good despite slow improvement after treatment.     

Exudative retinal detachment and retinitis associated with acquired syphilitic uveitis

PURPOSE: To describe three cases of exudative retinal detachment and focal retinitis associated with acquired syphilitic uveitis. METHODS: Three patients who were referred for evaluation of uveitis were examined. Slit-lamp examination, ophthalmoscopy, B-scan ultrasonography, fundus photography, and fluorescein angiography were performed before and after therapy. RESULTS: Each patient had uveitis with exudative retinal detachment, periphlebitis, and focal retinitis. Laboratory testing (fluorescent treponemal antibody absorption) revealed positive serology for active syphilis in all cases. Human immunodeficiency virus antibody testing was negative in all patients. Retinal detachment resolved in all cases after treatment with intravenous penicillin. Despite resolution of subretinal fluid, visual acuity remained poor in eyes in which the macula was detached. CONCLUSION: Syphilis is a cause of exudative retinal detachment. Antibiotic therapy can lead to retinal reattachment. Early recognition and treatment may prevent severe vision loss.     

Syphilitic uveitis in patients infected with human immunodeficiency virus

Background This work investigates the incidence and clinical features of syphilitic uveitis in patients infected with human immunodeficiency virus (HIV).Material and methods We retrospectively reviewed syphilitic uveitis in patients coinfected with HIV that presented at a referral center between July 2001 and November 2003.Results Twelve patients (20 eyes) were included. The ocular manifestations of syphilis led to the discovery of HIV-1 seropositivity in three patients. All patients were male and homosexual. One patient has been previously treated for syphilis with benzathine penicillin G. One patient presented with anterior uveitis and 11 patients had panuveitis or posterior uveitis. Necrotizing retinitis was noted in seven eyes (35%), posterior placoid chorioretinitis in six eyes (30%) and optic nerve involvement in five eyes (25%). Of nine patients with available cerebrospinal fluid (CSF) studies, seven (77.8%) had CSF abnormalities. Eleven patients were treated with intravenous penicillin G and one with intravenous ceftriaxone sodium. One patient required a second course of antibiotics to control uveitis. Ocular inflammation decreased and visual acuity improved in all nine patients for whom follow-up was available after treatment.Conclusion Manifestations of syphilitic uveitis in HIV-infected patients are multiple, with high frequencies of posterior uveitis, posterior placoid chorioretinitis, necrotizing retinitis and optic nerve involvement. Syphilitic uveitis in HIV-infected patients seems to have a more severe course and may relapse despite high-dose intravenous penicillin therapy.None of the authors has any financial interest in this study.     

Ocular syphilis: the new epidemic

AIM: To present the clinical presentation, diagnosis, and management of syphilitic uveitis in the context of an epidemic of syphilis in the UK. METHOD: Retrospective clinical case series. RESULTS: Six new cases of syphilitic uveitis presented to the Manchester Uveitis Clinic in 2004, after a 15-fold increase in the incidence of syphilis in the UK, including 615 cases in Greater Manchester in the 5 years to 2004. Four cases had secondary syphilis, two had latent disease, two had no rash, and two were HIV positive. Ocular involvement included anterior or panuveitis, retinitis, retinal vasculitis, and papillitis. All resolved on treatment including intramuscular procaine penicillin G with oral probenecid. CONCLUSIONS: Syphilis is much more common recently and syphilitic uveitis should be considered in all patients with rash and/or headache, where there is retinitis and/or retinal vasculitis, or in any uveitis of uncertain origin. Treatment is that of neurosyphilis.     

Corticosteroid-induced modulation of acute syphilitic posterior placoid chorioretinitis

PURPOSE: To report a case of corticosteroid-induced modulation of acute syphilitic posterior placoid chorioretinitis. DESIGN: Interventional case report. METHOD: A 38-year-old homosexual male who presented with a unilateral uveitis secondary to syphilis developed large placoid macular lesions after treatment with oral prednisone that resolved when the corticosteroids were discontinued. RESULTS: A cause-and-effect relationship was demonstrated between oral prednisone and the appearance of acute syphilitic posterior placoid chorioretinitis. CONCLUSIONS: The clinical appearance of posterior placoid chorioretinitis in syphilis may be modulated by the immune status of the patient.     

Visual evoked potential (VEP) and multifocal electroretinogram (mfERG) in ocular syphilitic posterior segment inflammation

The aim of this study is to correlate multifocal electroretinogram (mfERG) and visual evoked potential (VEP) changes with visual acuity and clinical features in patients with posterior segment inflammation secondary to syphilis. A retrospective interventional case series of 4 patients with visual loss secondary to syphilitic uveitis is reported. The mfERG (P1) showed diminished amplitudes and prolonged latency in 7 affected eyes. Visual acuity rapidly improved 2 weeks after initiation of therapy. OCT demonstrated anatomical recovery at 1 month. In three patients, visual acuity was restored to 6/6 at 6–9 months but mfERG responses remained significantly reduced and delayed for 12–15 months before recovery to normal levels. One patient developed a retinal detachment, but achieved 6/9 vision at 30 months. VEP changes, interpreted in combination with mfERG responses, showed evidence of optic nerve involvement in 6 eyes. Ocular findings, including posterior placoid chorioretinitis, are important diagnostic features of secondary and tertiary syphilis. Visual acuity and clinical recovery occur early with appropriate diagnosis and treatment, and precede full electrophysiological recovery of the outer retina-RPE complex. Ophthalmologists have the opportunity to play a key role in undetected or missed diagnoses of syphilis, and with appropriate treatment the visual prognosis is excellent.     

Syphilitic uveitis in HIV-positive patients: report of a case series, treatment outcomes, and comprehensive review of the literature

AIM: To report the clinical characteristics, treatment and outcomes of active syphilitic uveitis in human immunodeficiency virus (HIV) positive patients and compare them with the previously published data. METHODS: Retrospective analysis of the case series from an infectious disease center in southern China was conducted. Comprehensive review of previously published cases of HIV positive syphilitic uveitis was conducted using the PubMed and Web of Science databases and the references listed in the identified articles. RESULTS: Twelve HIV positive patients with active syphilitic uveitis were collected. All were male, with age of 36.3y (range 27 to 53y). Five (41.7%) had a history of syphilis, and three of them had received anti-syphilis treatment. Ocular manifestations included corneal epithelial defect (13%), complicated cataract (17.4%), vitreous opacity (82.6%), optic disc edema (26.1%), macular edema (30.4%), neuro-retinitis (43.5%), and retinal hemorrhage (26.1%). After standardized syphilitic treatment, intraocular inflammation was reduced and vision improved in all cases. The literature review summarizes 105 previously reported cases of HIV positive syphilitic uveitis. High serum rapid plasma regain (RPR) titers may be associated with severe uveitis and poor vision. Treatment with penicillin, ceftriaxone sodium, or penicillin plus benzylpenicillin instead of using benzylpenicillin alone can significantly improve best-corrected visual acuity (BCVA) in HIV positive ocular syphilis patients. CONCLUSION: For HIV positive syphilitic uveitis patients, prompt diagnosis and appropriate treatment and follow-up are paramount. In our series, the clinical manifestations are diverse. Syphilis patients treated by penicillin G or long-acting penicillin before may still develop syphilitic uveitis. Patients who relapse after long-term penicillin treatment can still benefit from penicillin G.     

Optic nerve involvement in syphilis in 4 patients]

BACKGROUND: Due to increasing numbers of cases syphilis again becomes more important in ophthalmology. Syphilitic ocular manifestations do not show any typical characteristics and therefore are often not diagnosed although a correct and early diagnosis with adequate therapy is very important for the visual outcome. PATIENTS: We report on four patients with luetic ocular fundus manifestations, who were referred to our clinic with unspecific ocular complaints. Funduscopic examination revealed in all patients a papilledema, which was bilateral in three patients and unilateral in one patient. Additional findings were a non-granulomatous uveitis anterior and a chorioretinitis in both eyes of a 61-year-old HIV positive patient with retinal scars from a bilateral acute retinal necrosis syndrome (ARN), a mild non granulomatous iridocyclitis in a 53-year-old patient and a bilateral chorioretinitis and a cystoid macular edema in a 37-year-old patient. A 54-year-old patient showed a vein branch occlusion. Serological analysis demonstrated active syphilis in all cases and an EBV-infection in two patients. After penicillin therapy the ocular findings resolved. CONCLUSION: In all cases of inflammatory fundus manifestations syphilis should be taken into consideration and serological lues tests should be performed routinely.