Intravitreal sustained-release dexamethasone implant for the treatment of persistent cystoid macular edema in ocular syphilis

Purpose: Re-emergent ocular syphilis in patients with Human immunodeficiency virus (HIV) co-infection has both diagnostic and management difficulties because of the overlapping risk factors. The clinical manifestations described in non-HIV may not be the same in patients with HIV coinfection. Immune recovery uveitis (IRU) may also alter the course of the disease causing recurrences. We studied the clinical features in correlation with CD4 counts, systemic immune status, sexual preferences and management outcomes in HIV/AIDS patients with ocular syphilis in the highly active antiretroviral treatment (HAART) era from a high endemic HIV population like India. Methods: Retrospective analysis of all patients with ocular syphilis and HIV/AIDS seen between 2016 and 2019 was done. Results: A total of 33 patients (56 eyes) with a CD4 count range of 42–612 cells/cu.mm were included. Ocular syphilis was found to be higher in individuals with high risk behavior such as men who have sex with men (MSMs) (45%). Panuveitis was the commonest manifestation (53.57%) and was even the presenting feature of HIV and syphilis in many patients. Significant vitritis, usually uncommon in HIV/AIDS immunocompromised patients was noted even with low CD4 counts in patients with ocular syphilis. Significant correlation was noted between ocular presentation and CD4 counts ( P < 0.05). Conclusion: Ocular syphilis presents differently in patients with HIV/AIDS. Diffuse retinitis is seen commonly in low counts (<100 cells/cu.mm). Classical placoid chorioretinitis lesions usually described in non-HIV individuals is uncommon in HIV patients and is seen in higher CD4 counts ( >400 cells/cu.mm). Ocular manifestations can be an indicator of the immune status of the patient. Not all patients with ocular manifestations have associated features of systemic syphilis. Ocular manifestations can be the first presentation of HIV/AIDS. Although, there is good response to systemic penicillin and HAART, recurrences and immune recovery uveitis (IRU) can also occur.

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“…Post-treatment IRU can be seen in HIV patients with ocular syphilis as was seen in our patients and can also present with CME. [ 8 ]…”

Section: Discussionmentioning

confidence: 99%

“…Immune recovery uveitis (IRU), in patients with ocular syphilis, can alter the course of the disease and may cause ocular morbidity due to recurrent inflammation. [ 8 9 10 ]…”

mentioning

confidence: 99%

Ocular syphilis in patients with human immunodeficiency virus/acquired immunodeficiency syndrome in the era of highly active antiretroviral therapy

Sridharan

Sukhija

Selvamuthu

et al. 2020

Indian J Ophthalmol

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“…The initial treatment for macular edema caused by inflammation is topical and periocular corticosteroids. CME, which did not respond to periocular corticosteroid, can be resolved with an intravitreal sustained-release dexamethasone implant ( 3 ). It can also be a big challenge because of the interaction of the therapy with the systematic treatment that requires immunosuppression.…”

Section: Introductionmentioning

confidence: 99%

Intravitreal Sustained-release Dexamethasone Implant in Treatment for Chronic Macular Edema in Syphilis Infection: a Case Report

Mehmedovic,

Drino,

Biscevic

et al. 2023

Med Arch

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Background: Macular edema results from many conditions, such as diabetic retinopathy, macular degeneration, inflammatory diseases, cataract operation, trauma, and tumors. Specifically, the capillary filtration rate should equal the speed of fluid removal from extracellular retinal tissue, such as the glial and retinal pigment epithelium cells layer (RPE). Once these forces are imbalanced, fluid accumulates in cystoid spaces within the inner layers of the retina. Objective: The main purpose of this case report is to show that macular edema caused by any inflammation, either bacteria, virus, or autoimmune origin, can be treated successfully, even if it is chronic. Case report: A 31-year-old man has been reported to our clinic with symptoms of blurry vision in the left eye, which occurred during the last year. Essential examinations included CDVA, IOP measurement, slit-lamp examination, indirect ophthalmoscopy, and OCT scan that showed significant macular edema (central foveal thickness of 353 microns). We initiated laboratory searches, such as blood, serology, and immunology testing for the next three months after his first visit, together with prescribed topical and periocular corticosteroid therapy. The test to VDRL (venereal disease research laboratory) for Syphilis and Toxocariasis came positive. We took the best decision and recommended further treatment with the intravitreal application of Dexamethasone Implant 0.7mg. One week after the intravitreal application of corticosteroids on the control exam, there were normal findings on the posterior segment with no macular edema (central foveal thickness of 269 microns). Conclusion: It is unexclusive that infection by Treponema pallidum (TP) causes isolated macular edema without any other symptoms on the anterior segment of the eye. It has indirect action on the macula, not just causing papilledema, retinal vasculitis, retinochoroiditis, and inflammatory disc edema, as expected. TP or the bacteria transmembrane protein (treponemal ligands) directly acting on vascular endothelial cells of the RPE cells, will be the key to the most certain mechanism of this condition. It is related to the possibility of the secretion of cytokines and the interactions between immune cells indirectly.

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Intravitreal Dexamethasone Implant as a Sustained Release Drug Delivery Device for the Treatment of Ocular Diseases: A Comprehensive Review of the Literature

et al. 2020

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Drug delivery into the vitreous chamber remains a great challenge in the pharmaceutical industry due to the complex anatomy and physiology of the eye. Intravitreal injection is the mainstream route of drug administration to the posterior segment of the eye. The purpose of this review is to assess the current literature about the widening use of the intravitreal 0.7 mg dexamethasone (Dex) implant, and to provide a comprehensive collection of all the ocular disorders that benefit from Dex administration. Although anti-vascular endothelial growth-factors (VEGFs) have been largely indicated as a first-choice level, the Dex implant represents an important treatment option, especially in selected cases, such as vitrectomized eyes or patients in whom anti-VEGF failed or are contraindicated. In this article, the safety profile as well as the list of the possible complications related to intravitreal Dex injection are also discussed.

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Intravitreal sustained-release dexamethasone implant for the treatment of persistent cystoid macular edema in ocular syphilis

Cited by 4 publications

References 21 publications

Ocular syphilis in patients with human immunodeficiency virus/acquired immunodeficiency syndrome in the era of highly active antiretroviral therapy

Ocular syphilis in patients with human immunodeficiency virus/acquired immunodeficiency syndrome in the era of highly active antiretroviral therapy

Intravitreal Sustained-release Dexamethasone Implant in Treatment for Chronic Macular Edema in Syphilis Infection: a Case Report

Intravitreal Dexamethasone Implant as a Sustained Release Drug Delivery Device for the Treatment of Ocular Diseases: A Comprehensive Review of the Literature

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