以视力损害为首发症状的二期梅毒

目的 探讨以视力损害为首发症状的二期梅毒的临床表现及其治疗。方法 回顾分析1998年9月至2008年10月以眼部表现为首发症状的梅毒患者的临床资料。结果 11例患者均以急性视力下降为起病症状或主要症状，其中2例同时伴有皮疹，9例于眼部损害出现后发现皮疹。所有患者血清RPR及TPHA均阳性。眼部表现中，葡萄膜炎9例（虹膜睫状体炎、脉络膜炎和全葡萄膜炎），视神经炎2例。8例患者双眼受损，3例单眼受损。用青霉素或头孢曲松钠不同剂型或剂量治疗后，9例患者视力完全恢复，2例视力部分恢复。结论 眼梅毒在二期梅毒中少见但存在，且临床缺乏特征性。当常规眼科治疗无效时，应考虑梅毒性眼病的诊断并进行梅毒血清学检查。

Secondary syphilis with ocular impairment as the initial symptom

Objective To retrospectively assess the clinical manifestations and treatment of secondary syphilis with ocular impairment as the initial symptom. Methods Clinical data were retrospectively analyzed on secondary syphilis with ocular impairment as the initial symptom collected from September 1998 to October 2008. Results There were 11 syphilitic patients presenting acute ocular impairment as their initial manifestation. Skin eruptions developed simultaneously with ocular impairment in 2 patients, following ocular impairment in 9 patients. All patients were positive for rapid plasma reagent test (RPR) and treponema pallidum haemagglutination assay (TPHA), but negative for HIV. Of these patients, 9 suffered from uveitis (iridocyclitis, choroiditis or panuveitis), 2 from optic neuritis; 3 had unilateral ocular involvement, 8 had bilateral ocular involvement. After treatment with injected penicillin or ceftriaxone sodium, 9 patients experienced complete visual recovery, 2 partial visual recovery. Conclusions Ocular impairment occurs in patients with secondary syphilis at a low incidence, with no characteristic clinical manifestations. For patients who have no response to conventional ocular therapy, ocular syphilis should be considered and serological examination for syphilis is recommended.