The ghost of the great imitator: prognostic factors for poor outcome in syphilitic uveitis

Abstract

BackgroundSyphilitic uveitis is reemerging globally, may lead to any type of intraocular inflammation, and is potentially sight-threatening. We aim to characterize clinical features and prognostic factors in patients with syphilitic posterior uveitis.MethodsRetrospective chart review at two tertiary university-based referral centers in Brazil. Clinical data, laboratory results, and treatment outcomes were analyzed. Statistical analysis was performed using Fisher’s exact test for categorical variables and Mann-Whitney U test for continuous variables.ResultsForty-four patients (81 eyes) were consecutively diagnosed with syphilitic posterior uveitis between March 2011 and April 2013.Thirty-one were male (70.5%) and the mean age was 43.8 years (range 15–81). HIV confection was disclosed in 12 patients (29.3%). The most prevalent finding was vitritis (85.2%), followed by retinal involvement (76.4%) and optic disc abnormalities (63.5%). After treatment, mean visual acuity improved from 1.2 (20/320) to 0.6 (20/80; median 20/30), but 19 eyes (23.5%) persisted with ≤ 1.0 (20/200). Factors associated with final visual acuity ≤ 1.0 despite therapy were prior use of systemic corticosteroids (p = 0.001), higher Venereal Disease Research Laboratory titers (p = 0.004), longer duration of symptoms (p = 0.024), and worse initial VA (p < 0.001).ConclusionsSyphilitic uveitis is reemerging. Delayed diagnosis and inadvertent use of systemic corticosteroids are potentially modifiable prognostic factors to be considered for possibly improving outcomes.

Clinical Features And Incidence Of Visual Improvement Following Systemic Antibiotic Treatment In Patients With Syphilitic Uveitis

“…Furthermore, an increased likelihood of recovery of VA to ≥ 20/25 was observed among eyes receiving early antibiotic treatment and eyes with a better presenting VA, which is consistent with previous studies. [12,13,17,32] In contrast, eyes with a presenting VA of ≤ 20/200 were less likely to regain VA, which was attributed to the presence of retinal scarring due to extensive retinitis lesions, RD, and recalcitrant CME. The anatomic location of uveitis was predictive of VA improvement.…”

“…[1,6] However, visual acuity (VA) may be severely affected once ocular tissue is involved. [8, [10][11][12] Prompt antibiotic treatment is associated with a more favorable visual prognosis than delayed treatment.…”

“…[8, 13,14] Poor visual prognosis is associated with delayed treatment, poor VA at presentation, inadvertent systemic corticosteroid use prior to syphilis treatment, and HIV coinfection. [12,13,[15][16][17][18] Likewise, a resurgence of syphilis has been reported in Thailand. A ve-fold increase in the annual prevalence of syphilis was observed from 2008 to 2018, increasing from 2.16 to 11.51 cases per 100,000 population.…”

Manifestações oculares de doenças sistêmicas: uveítes, Oftalmopatia de Graves e Síndrome de Sjögren

“…Apesar do que em geral há uma boa resposta ao tratamento específico, a demora na realização do tratamento e o desenvolvimento de sequelas podem levar à deficiência visual 23 . Em um recente estudo com pacientes tratados em quatro centros brasileiros, por exemplo, aproximadamente 40% dos olhos acometidos apresentavam acuidade visual pior que 20/40 (ou 0.5 em uma tabela com escala decimal) após o tratamento 17 .…”

Design and characterization of selective laser‐melted Ti6Al4V–5Cu alloy for dental implants

“…Infection and inflammation were always the focus problems in the clinical application of biomaterials. [ 6 ] Therefore, the antibacterial titanium alloy was proposed and widely studied.…”