Spontaneous Improvement of Syphilis Chorioretinitis: Case Report and Review of the Literature

Abstract

Spontaneous improvement of syphilis chorioretinitis is possible. Clinicians should keep a high index of suspicion and consider syphilis chorioretinitis in diseases that affect the outer retina even with spontaneous improvement.

<p>Perceived difficulties and barriers to uptake of Descemet’s membrane endothelial keratoplasty among surgeons</p>

“…The first successful DMEK surgery was performed more than a decade ago,7 and while the number of DMEK procedures being performed rose every year between 2012 and 2016, as per data provided by the Eye Bank Association of America, widespread adoption of the technique by corneal surgeons has been slow, because of the perceived difficulty of the procedure 1,8. In our study, we found steps related to graft preparation, graft insertion, and unfolding as being the most difficult to learn by corneal surgeons.…”

“…Studies have also found greater cell loss in the S-stamp area in preloaded DMEK grafts, often with complete loss of all cells in the stamped area 14. DMEK presents a steep learning curve and surgical skills that are entirely different from DSEK 8. Experienced DSEK surgeons may not be as compelled to learn DMEK, especially when they might be achieving satisfactory results with their current technique.…”

“…Experienced DSEK surgeons may not be as compelled to learn DMEK, especially when they might be achieving satisfactory results with their current technique. Furthermore, unlike certain procedures, such as cataract surgery, which has well-defined algorithms for every step of the surgery, a similar “if this, then that” algorithm does not currently exist for DMEK 8. Therefore, the steep learning curve combined with surgeons not knowing the specific “next steps” of surgery and the higher rate of complications experienced initially currently limit the amount of DMEK surgery performed today 15.…”

Syphilitic Outer Retinopathy: A Masquerading Diagnosis Revealed After Steroid-Induced Progression to Panuveitis

“…The spontaneous resolution of SOR has also been described. 5 ASPPC has been more commonly reported than SOR as a posterior segment manifestation of ocular syphilis, and the effect of oral steroids on ASPPC is also controversial. Ormaechea et al 7 described a case of ASPPC in which oral steroids resulted in the resolution of the placoid retinal lesions when an initial diagnosis of autoimmune disease was incorrectly made; however, vitritis and exudative retinal detachment worsened and penicillin was eventually required for the complete resolution of ocular findings.…”

“…1 Indeed, in four of the seven cases published to date, SOR was initially diagnosed as acute zonal occult outer retinopathy and two of these cases presented with normal fundus examination. [2][3][4][5] Syphilitic outer retinitis can present with minimal funduscopic changes; however, outer retinal abnormalities can be identified on fundus autofluorescence imaging and OCT. [2][3][4] Hyperreflective nodularity of the RPE is a feature of both ASPPC and SOR that may help raise suspicion for syphilis and distinguish SOR from acute zonal occult outer retinopathy, as might the presence of vitreous cell. 4,6 Additional potential distinguishing features of acute zonal occult outer retinopathy include a demarcation line most apparent on fundus autofluorescence and a trizonal pattern on multimodal imaging.…”