Multimodal imaging analyses of hyperreflective dot-like lesions in acute syphilitic posterior placoid chorioretinopathy

Abstract

BackgroundRetrospective review of one acute syphilitic posterior placoid chorioretinitis (ASPPC) case with serological evidence of syphilis who had ocular signs and symptoms not attributable to other diseases. Enface and spectral-domain optical coherence tomographySD-OCT were analyzed at the time of presentation and at 1-month visit following initiation of treatment. The study patient underwent standard treatment for neurosyphilis.ResultsOphthalmic examination and imaging studies were consistent with the diagnosis of ASPPC. The patient age was 33 year-old and the baseline visual acuity was 20/400 and 20/80 in the right and left eyes, respectively. At presentation, SD-OCT scans showed disruption and loss of the ellipsoid zone (EZ), small nodular elevations on retinal pigment epithelium (RPE) and punctate hyperreflectivity in the choroid. Enface OCT at the level of RPE and EZ demonstrated multiple hyperreflective dot-like lesions simmetrically distributed within the macular area. These dot-like lesions corresponded to the small nodular elevations on RPE and to disruption/loss of EZ observed with SD-OCT. One month after neurosyphilis therapy, the visual acuity improved and the outer retinal changes partially reversed in both eyes.ConclusionsWe report the outer retinal findings and its correlation using both en-face and SD-OCT in a patient with ASPPC. En-face OCT imaging provides a more precise outer retinal layers analyses allowing a better understanding of the ASPPC pathophysiology.

Angiography and En Face Optical Coherence Tomography Findings in Acute Syphilitic Posterior Placoid Chorioretinopathy

“…Similar to previous reports [4, 8, 9, 10], nodular elevations of the RPE were seen on B-scan OCT, which are typical in this entity and were observed in our patient as well. These RPE changes seem to be well correlated with hyperautofluorescent dots seen on fundus autofluorescence imaging [11].…”

“…En face OCT allowed us to observe a photoreceptor alteration seen as multiple hyperreflective clumps in the ellipsoid/RPE layer. Lima et al [9] support the assumption that these dots corresponded to the hyperreflective nodularity of the RPE seen on SD-OCT, and Zett et al [4] could co-localize exactly these lesions to the hyperfluorescent dot-like lesions seen on fundus autofluorescence imaging.…”

Curvilinear branching retinal deposits in acute syphilitic posterior placoid chorioretinitis: A novel pattern on en face optical coherence tomography

“…It is different to previous reports of en face OCT imaging that showed multifocal dots at the level of the RPE . The branching pattern may represent immune complex deposits on the surface of the RPE or shed photoreceptor outer segments . Fundus autofluorescence may have been helpful in distinguishing the nature of the material but was not performed.…”

Spectral Domain-Optical Coherence Tomography and Optical Coherence Tomography Angiography Findings in a Case of Acute Syphilitic Posterior Placoid Chorioretinitis

“…High-resolution spectral-domain optical coherence tomography (SD-OCT) revealed outer retinal changes such as disruption and loss of both the EZ and external limiting membrane, and nodular thickening of the RPE [8,9]. En-face OCT and OCT-A revealed typical nodular elevations of the RPE as described by Lima et al [10].…”