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、眼痛、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200mg2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.     

Syphilitic retinitis and uveitis in HIV‐positive adults

Background: The incidence of new infection with syphilis is increasing, particularly in men who have sex with men, with HIV co‐infection common. There has been a corresponding increase in ophthalmic manifestations that can be varied in presentation. Methods: Thirteen consecutive patients with syphilitic uveitis presenting to two ophthalmic departments in Sydney are described. Results: Twelve patients were male, of whom 10 were homosexual and six HIV‐positive. Peripheral retinitis with panuveitis was the commonest ophthalmic presentation (n = 7, 54%), and six cases were initially treated with vitreous tap and intravitreal foscarnet as a precaution in case of viral retinitis. Retinitis was present in six of six (100%) HIV‐positive and only one of seven (14%) HIV‐negative patients (χ²10.6, P < 0.01). Other ophthalmic presentations included anterior uveitis, vitritis, multifocal choroiditis, scleritis and papillitis. All patients responded to 10–14 days' intravenous penicillin with good final visual outcomes (6/12 or better in all eyes). Conclusions: This case series reinforces the importance of considering syphilis in the differential diagnosis of many ocular presentations, but in particular retinitis. Retinitis appears to be the predominant presentation in HIV‐infected individuals, suggesting that HIV infection may somehow modulate the disease.     

Syphilitic uveitis: a review of clinical manifestations and treatment outcomes of syphilitic uveitis in human immunodeficiency virus‐positive and negative patients

The incidence of syphilis and syphilitic uveitis in our community is increasing. The prevalence of associated neurosyphilis is unknown, and it remains unclear whether syphilitic uveitis should be treated as secondary syphilis with intramuscular penicillin or neurosyphilis with intravenous penicillin. The (English language) literature was reviewed for all unique cases of syphilitic uveitis reported from 1984 to June 2008. For each case the following data were recorded: the clinical features of the syphilis, the uveitis and any associated neurosyphilis, the human immunodeficiency virus (HIV) status, lumbar puncture findings, treatment and follow up. We identified 143 patients in 41 original reports of syphilitic uveitis (93 HIV‐positive and 50 HIV‐negative). Posterior uveitis was reported in 79 patients (55.2%); panuveitis was reported in 36 patients (25.2%); anterior/intermediate uveitis was reported in only 28 patients (19.6%). Lumbar puncture findings were abnormal in 82 patients (57%), and the majority of these patients (76%, 62 out of 82) were HIV‐positive. One hundred and ten (77%) patients were treated with intravenous therapy, usually penicillin. Most recovered from the syphilis, however, a proportion did not recover full vision. There were 13 (9%) treatment failures, which tended to occur in patients who were HIV‐positive (n = 11), had abnormal lumbar puncture findings (n = 8) and/or were treated (n = 11) intravenously. There is a high incidence of abnormal lumbar puncture findings in patients with syphilitic uveitis and a strong association with HIV infection. Most received appropriate therapy with a low relapse rate, which was not related to the type of therapy.     

Rhegmatogenous Retinal Detachment in Patients with Acute Syphilitic Panuveitis

Purpose: To describe the clinical characteristics and surgical management of rhegmatogenous retinal detachment (RD) in patients with acute syphilitic panuveitis.

Methods: Retrospective case series and comprehensive literature review.

Results: Including present and previously reported cases, we identified 11 eyes in 8 patients with acute syphilitic panuveitis that developed a rhegmatogenous RD. Seven of 11 eyes (63.6%) were repaired with a combined scleral buckling, vitrectomy, and endolaser photocoagulation surgery; 1 eye (9.1%) was repaired with scleral buckling only; and 2 eyes (18.2%) with vitrectomy only. Cryotherapy was used to treat a giant retinal tear in 1 eye (9.1%). Four eyes (36.4%) redetached and 3 underwent a second vitrectomy surgery.

Conclusions: Although uncommon, rhegmatogenous RD can occur in patients with moderate to severe acute syphilitic panuveitis. We believe scleral buckling, vitrectomy, endolaser photocoagulation, and silicone oil tamponade give the best chance for successful retinal reattachment.     

Hypotony Maculopathy in a Patient with HLA-B27-associated Uveitis

Purpose: To describe a patient with HLA-B27-associated anterior uveitis who developed hypotony maculopathy. Methods: Visual acuity, biomicroscopic slit-lamp examination, and fluorescein angiogram. Results: Following an episode of acute anterior nongranulomatous HLA-B27-associated uveitis, the patient developed decreased vision, choroidal folds, optic disc edema, and a serous exudative detachment characteristic of hypotony maculopathy. The intraocular pressure was noted to be 4 mmHg. Following therapy with topical 1% prednisolone acetate and 5% homatropine, both the intraocular pressure and retinal anatomy normalized. Conclusions: Hypotony maculopathy may be seen in patients with HLA-B27-associated uveitis and should be considered as a cause of vision loss in patients with this condition.     

Acute Syphilitic Posterior Placoid Chorioretinitis Misdiagnosed as Systemic Lupus Erythematosus Associated Uveitis

ABSTRACT

Purpose: The authors report a case of a systemic lupus erythematosus (SLE) patient who suffered rapid loss of vision after being misdiagnosed as SLE associated uveitis and treated with glucocorticoid. She was eventually diagnosed with acute syphilitic posterior placoid chorioretinitis (ASPPC) after further serological inspection and detailed ophthalmic examination, and gained improved visual acuity through massive penicillin G treatment.

Methods: Retrospective review of a case note.

Conclusions: Concealment of syphilis history and absence of serological examination, coupled with its rarity, can make the diagnosis of ASPPC extremely difficult, especially when combined with simultaneous systemic or immune diseases. A high index of suspicion for syphilis and timely serological examination are crucial for early diagnosis and prompt treatment. Even if the ASPPC shows signs of spontaneous improvement, prompt and sufficient antibiotic treatment remains essential to prevent sight-threatening complications.     

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.     

中间型葡萄膜炎并发复杂性视网膜脱离的玻璃体手术治疗

目的:探讨中间型葡萄膜炎并发复杂性视网膜脱离的临床特征及玻璃体切除联合眼内填充术的治疗效果。方法:回顾性分析我院2000-01/2005-06收治的11例(共11眼)中间型葡萄膜炎并发复杂性视网膜脱离病例术前及术后详细的临床资料。所有患者均接受巩膜外环扎,玻璃体切除联合眼内填充术治疗,术中9眼行硅油充填,2眼填充长效惰性气体。术后随访12～66mo。结果:术后11眼均获视网膜良好复位及视力增进。随访期中有7眼于6～12mo取出硅油,硅油取出后2眼因周边部PVR或葡萄膜炎复发导致视网膜脱离复发,未取硅油的4眼(包括2只再手术眼)视网膜平伏。结论:中间型葡萄膜炎并发的复杂性视网膜脱离,尤其存在周边部纤维及血管膜的牵引时,玻璃体切除联合眼内填充术效果确切,周边部PVR和葡萄膜炎复发是术后限制视网膜复位的主要原因。     

梅毒性巩膜炎的临床特征与治疗

目的 分析总结梅毒性巩膜炎患者的临床特征及治疗结果.方法 对我院2011年至2016年确诊的梅毒性巩膜炎患者临床资料进行回顾性研究,对梅毒性巩膜炎的临床特征及预后结果进行评价与分析.结果 7例(7眼)患者经临床及血清学检查确诊为梅毒性巩膜炎.所有患者就诊前未知梅毒感染,有3例患者眼部是唯一的临床表现.梅毒血清学检查包括梅毒快速血浆反应素试验及梅毒螺旋体颗粒凝集试验,两者均为阳性.所有患者HIV检测均为阴性,排除HIV感染.7例患者均为单眼发病,病程1周～2a.患者均以不同程度的眼红、眼痛伴视力下降等为主诉就诊.患者中2例为前部浅层巩膜炎,3例为前部结节性前巩膜炎,1例为弥漫性前巩膜炎,1例为弥漫性表层巩膜炎伴有急性梅毒性后部鳞状脉络膜视网膜病变.所有患者均接受青霉素治疗,治疗后巩膜炎症均完全消退.结论 梅毒感染性巩膜炎较少见且易被误诊,主要表现为各种类型的前部巩膜炎.对于可疑病例要进行梅毒血清学检测以明确诊断.正确驱梅治疗后,患者预后较好.     

梅毒—一个尚未充分认识的引起年老患者术后葡萄膜炎的原因(英文)

目的:报告1例年长患者因梅毒继发的术后葡萄膜炎。方法:一例76岁的马来西亚男性患者,双眼为未成熟期白内障,右眼顺利进行了白内障超声乳化术,既往无葡萄膜炎病史。术后5d,右眼突然出现视物模糊,眼部检查发现角膜弥漫性水肿、中度前房反应和眼压升高。结果:局部应用抗生素和类固醇药物效果良好,眼压经用抗青光眼药得到控制。然而,术后3wk,右眼再次发生疼痛、红肿、视物模糊,眼部检查显示严重的前葡萄膜炎伴有羊脂状角膜后沉积物出现,VDRL和TPHA阳性证实为梅毒,通过全身注射青霉素类药物和局部应用类固醇药物,病情明显好转。结论:这个病例证明在年长患者梅毒是未被充分认识的引起术后葡萄膜炎的病因,应用青霉素可获得快速显著的治疗效果。     

Simultaneous Bilateral Exudative Retinal Detachment and Peripheral Necrotizing Retinitis as Presenting Manifestations of Concurrent HIV and Syphilis Infection

Purpose: To describe an unusual case of simultaneous bilateral exudative retinal detachment and peripheral necrotizing retinitis as presenting manifestations of concurrent HIV and syphilis infection. Case report: A previously healthy 35-year-old Caucasian male was first seen for bilateral sudden visual loss. Ophthalmoscopy showed bilateral exudative retinal detachment involving the posterior pole and a placoid-like area of peripheral necrotizing retinitis in his left eye. Physical examination revealed anal condylomata and aphthous oral lesions. Laboratory investigations confirmed the diagnosis of concurrent HIV and syphilis infection. Ocular lesions resolved in response to anti-syphilitic medication administered for three weeks. Discussion: This case demonstrates the importance of considering syphilis as a cause of atypical retinitis in the HIV-positive population.     

Syphilitic Scleritis

A 47-year-old man developed a painful right red eye for 72 hours with a 20/25 decreased visual acuity. He had no medical history. Slit-lamp examination revealed a painful nodular scleritis at the equator of the globe in the infero-temporal quadrant. There was a moderate intraocular inflammation in the anterior segment. Fundus examination revealed a grade 1 hyalitis and a focal retinitis with vasculitis and arterio-veinous occlusion toward the scleritis zone. Syphilis and HIV serology were positive and the scleritis resolved 5 days after a penicillin G medication. Syphilitic scleritis are relatively uncommon.     

Intravascular Lymphoma Mimicking a Vogt-Koyanagi-Harada Disease

Purpose: To report a case of intravascular lymphoma (IVL) mimicking a Vogt-Koyanagi-Harada disease (VKH).

Design: Case report.

Methods: A 38-year-old man was referred for blurred vision, headache, and hearing loss. Examination demonstrated vitritis and subretinal detachments in each eye. Cerebral fluid analysis showed lymphocytic meningitis. Cerebral MRI was normal. A diagnosis of VKH disease was made.

Results: Steroid treatment was introduced, after which all symptoms disappeared. Six months later, the patient returned with paraplegia and confusion. Cerebral MRI revealed hypodense periventricular lesions. A stereotaxic biopsy confirmed the diagnosis of IVL. The patient died a few months later.

Conclusion: IVL may have many revealing aspects, including ophthalmologic symptoms.     

En-Face Optical Coherence Tomography of Acute Syphilitic Posterior Placoid Chorioretinopathy

Purpose: To report a unique case series of acute syphilitic posterior placoid chorioretinopathy (ASPPC) correlating en-face optical coherence tomography (OCT) with standard imaging modalities.

Methods: In this retrospective case series, multimodal imaging was performed in three ASPPC patients at the time of disease presentation.

Results: Clinical and laboratory findings were consistent with the diagnosis of ASPPC. In all the study patients, multiple hyperreflective dot-like lesions distributed in the macular area and observed with en-face OCT at the level of retinal pigment epithelium (RPE) corresponded to the nodular RPE elevations on cross-sectional OCT and to the hyperauto?uorescent spots on fundus autofluorescence. In addition, the cross-sectional OCT scans showed disorganization of the outer retinal bands and punctate choroidal hyperre?ectivity.

Conclusion: By combining en-face OCT with multimodal imaging analysis, we propose that a primary inflammation at the level of the choroid may be the pathogenic mechanism for the occurrence of outer retinal band abnormalities.     

伴有严重渗出性视网膜病变的Coats病1例

Coats病是散发的非遗传性疾病,不伴有系统性异常,常单眼发病。我们报道1例27岁俄罗斯Coats病女患者。眼底检查显示左眼下方视网膜血管瘤样改变,血管迂曲扩张、呈串珠状,伴有严重的浆液性视网膜脱离。中心凹亦脱离,有成簇的白色沉积物。     

Intravenous Ceftriaxone for Syphilitic Uveitis

Purpose: Report of clinical/multimodal imaging outcomes of patients with syphilitic uveitis alternatively treated with intravenous(IV) ceftriaxone, due to unavailability of penicillin G.

Methods: Chart review of all cases of syphilitic uveitis presenting to Hospital São Geraldo/HC-UFMG and treated with intravenous ceftriaxone, between January and August 2014. Clinical, serological and ophthalmological data were collected.

Results: Twelve consecutive patients with syphilitic uveitis receiving IV ceftriaxone were identified. All 24 eyes had active intraocular inflammation on clinical examination. All patients received IV ceftriaxone (2–4 g daily) for 14–21 days, supplemented with oral corticosteroid as needed in 9 patients (75%), after documented clinical response. Improvement in intraocular inflammation was seen in all 24 eyes, with median best-corrected visual acuity (BCVA) increasing from 20/50 to 20/20, after a mean follow-up of 5.3 months.

Conclusion: IV ceftriaxone may be an effective alternative for treatment of syphilitic uveitis, in the setting of unavailability of penicillin G.     

Vitreous intercellular adhesion molecule 1 in uveitis complicated by retinal detachment

AIMS—The vitreous levels of soluble intercellular adhesion molecule 1 (sICAM-1) were investigated in uveitic eyes undergoing vitrectomy for retinal detachment (RD) or other complications, and the presence of this molecule was related to disease activity and vitreous levels of the cytokine tumour necrosis factor α (TNFα), known to upregulate ICAM-1 expression on various cells.
METHODS—Vitreous and serum samples from 23 patients with either active or quiescent uveitis undergoing retinal surgery were examined for the levels of immunoreactive sICAM-1 and TNFα by ELISA methods, and for the presence of biologically active TNFα. Vitreous from non-uveitic eyes with rhegmatogenous retinal detachment (RRD), macular holes or cadaveric eyes were used as controls.
RESULTS—As a whole, vitreous from uveitic eyes complicated or uncomplicated by RRD contained significantly higher levels of sICAM-1 than vitreous from non-uveitic eyes with RRD alone (p < 0.0005), eyes with macular holes (p< 0.0001), or normal cadaveric vitreous (p < 0.0001). The proportion of vitreous containing >20 ng/ml sICAM-1 (> four times the normal values) was significantly higher in eyes with uveitis complicated by RRD than in those eyes without RRD (Fisher's test, p= 0.02), and although levels of sICAM-1 were higher in eyes with active uveitis than in those with quiet disease (p < 0.02), this could not be dissociated from the increase caused by RRD. There was a relation between the vitreous levels of sICAM-1 and those of immunoreactive TNFα (Spearman's correlation coefficient; r = 0.601, p = 0.006), but not between the vitreous levels of sICAM-1 and those of biologically active TNFα.
CONCLUSION—Increased vitreous sICAM-1 levels and the association of this molecule with the presence of immunoreactive TNFα in uveitic eyes confirm the operation of cytokine mediated vascular reactions at the blood-retinal barrier during the development of this condition. The persistence of high vitreous levels of sICAM-1 in eyes with uveitis complicated by RRD despite previous immunosuppression may indicate a low rate of clearance of inflammatory molecules from the vitreous cavity and an exacerbation of the existing inflammatory process by the retinal detachment itself.

Keywords: vitreous; retinal detachment; ICAM-1; TNFα; uveitis     

Fluorescein angiographic findings in cases with intermediate uveitis in the inactive phase

BACKGROUND: To determine fundus fluorescein angiography (FA) findings in cases with intermediate uveitis in the inactive phase. METHODS: This prospective study included all eligible cases with a diagnosis of intermediate uveitis that were treated at the uvea unit of Trakya University ophthalmology department between January 2002 and January 2004. Study criteria included patients in the inactive phase who had no complaints, no biomicroscopic or ophthalmoscopic inflammatory findings in the anterior and posterior segments, and no period of inflammation that had occurred within the previous 6 months. Cases receiving immunosuppressive treatment were not excluded. FA was performed in all cases, which were evaluated by 2 independent observers. RESULTS: A total of 21 eyes from 21 cases with intermediate uveitis were included in the study. FAs of the cases were taken approximately 8.8 (SD 5.4) months (range 6-23 months) after the last activation. In these FAs, no pathological findings were identified in 5 eyes (23.8%); optic disc hyperfluorescence was observed in 14 eyes (66.7%); large vein staining was observed in 2 eyes (9.5%); peripheral venous leakage was observed in 6 eyes (28.6%); and cystoid macular edema was observed in 5 eyes (23.8%). INTERPRETATION: These findings indicate that retinal vascular inflammatory changes persist in cases with intermediate uveitis even if the clinical manifestations have been treated.     

Massive Exudative Retinal and Choroidal Detachments Following Scleral Buckling Surgery

Three aphakic male patients underwent successful scleral buckling surgery for unilateral rhegmatogenous retinal detachment. Within a two-week postoperative period, each developed severe ocular pain with massive exudative retinal and choroidal detachments resembling recurrent rhegmatogenous or traction retinal detachment or implant infection. Systemic prednisone therapy resulted in prompt resolution of ocular pain and reabsorption of subretinal and suprachoroidal fluid. It is important to recognize this uncommon postoperative syndrome so that proper medical therapy may be initiated and unnecessary additional retinal or vitreous surgery can be avoided.