Macular Optical Coherence Tomography Findings in Patients With Syphilitic Optic Neuropathy-A Case Series and Systematic Review.

IF 2 4区 医学 Q3 CLINICAL NEUROLOGY
Irina Sverdlichenko,Heather M McDonald,Jim Shen Chu Xie,Edward A Margolin
{"title":"Macular Optical Coherence Tomography Findings in Patients With Syphilitic Optic Neuropathy-A Case Series and Systematic Review.","authors":"Irina Sverdlichenko,Heather M McDonald,Jim Shen Chu Xie,Edward A Margolin","doi":"10.1097/wno.0000000000002188","DOIUrl":null,"url":null,"abstract":"BACKGROUND\r\nSyphilis is a sexually or congenitally acquired infectious disease that can affect multiple organs systems, including the eye. When left undiagnosed and untreated, it can lead to significant morbidity and mortality. Syphilitic optic neuropathy can be difficult to diagnose because it can mimic many other nonsyphilitic causes of optic nerve involvement, leading to delay in treatment. Diagnosing ocular syphilis may be facilitated by assessing for specific outer retina abnormalities on macular optical coherence tomography (OCT).\r\n\r\nMETHODS\r\nThis was a case series and case-based systematic review. For the case series, a retrospective chart review was conducted of all patients who presented to a tertiary university-affiliated neuro-ophthalmology practice over 6 months with undifferentiated optic neuropathy and were eventually diagnosed with syphilitic optic neuropathy. For the systematic review, OVID MEDLINE, EMBASE, and COCHRANE CENTRAL databases were searched to identify all cases of syphilitic optic neuropathy with macular OCT. The primary research outcome was the prevalence of cases with outer retinal abnormalities on OCT.\r\n\r\nRESULTS\r\nFour cases were identified that were eligible for inclusion. The ages ranged from 27 to 62 years old, and 2 of the patients were female. On examination, vision ranged from Snellen 20/50 to hand motion; all patients had optic neuropathy, and macular OCT revealed chorioretinitis characterized by retinal pigment epithelium (RPE) excrescences. The patients subsequently underwent uveitis workup and were diagnosed with syphilis. They were treated with intravenous penicillin and showed improvement in outer retina appearance on follow-up. The systematic review consisted of 24 cases and 35 eyes with syphilitic optic neuropathy and reported macular OCT findings. Eighty-three percent (20/24) were males, and the mean age was 47.7 years (SD: 49.2). The mean visual acuity at presentation was Snellen 20/57. On fundoscopy, 25.7% (9/35) of eyes had vitritis, whereas 22.8% (8/35) had placoid chorioretinal lesions. On OCT, 45.7% (16/35) of eyes had abnormal outer retina findings, most commonly disruption of the ellipsoid zone (EZ) and/or RPE excrescences. All patients were treated with penicillin or ceftriaxone, and final mean visual acuity was Snellen 20/29.\r\n\r\nCONCLUSIONS\r\nAll 4 patients identified in the case series, and nearly half of patients with syphilitic optic neuropathy described in the literature had concurrent-specific outer retina abnormalities (disruption of EZ and/or placoid chorioretinitis in the form of RPE excrescences) seen on macular OCT. We recommend that clinicians obtain macular OCT for all patients presenting with undifferentiated optic neuropathy.","PeriodicalId":16485,"journal":{"name":"Journal of Neuro-Ophthalmology","volume":"13 1","pages":""},"PeriodicalIF":2.0000,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Neuro-Ophthalmology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/wno.0000000000002188","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

BACKGROUND Syphilis is a sexually or congenitally acquired infectious disease that can affect multiple organs systems, including the eye. When left undiagnosed and untreated, it can lead to significant morbidity and mortality. Syphilitic optic neuropathy can be difficult to diagnose because it can mimic many other nonsyphilitic causes of optic nerve involvement, leading to delay in treatment. Diagnosing ocular syphilis may be facilitated by assessing for specific outer retina abnormalities on macular optical coherence tomography (OCT). METHODS This was a case series and case-based systematic review. For the case series, a retrospective chart review was conducted of all patients who presented to a tertiary university-affiliated neuro-ophthalmology practice over 6 months with undifferentiated optic neuropathy and were eventually diagnosed with syphilitic optic neuropathy. For the systematic review, OVID MEDLINE, EMBASE, and COCHRANE CENTRAL databases were searched to identify all cases of syphilitic optic neuropathy with macular OCT. The primary research outcome was the prevalence of cases with outer retinal abnormalities on OCT. RESULTS Four cases were identified that were eligible for inclusion. The ages ranged from 27 to 62 years old, and 2 of the patients were female. On examination, vision ranged from Snellen 20/50 to hand motion; all patients had optic neuropathy, and macular OCT revealed chorioretinitis characterized by retinal pigment epithelium (RPE) excrescences. The patients subsequently underwent uveitis workup and were diagnosed with syphilis. They were treated with intravenous penicillin and showed improvement in outer retina appearance on follow-up. The systematic review consisted of 24 cases and 35 eyes with syphilitic optic neuropathy and reported macular OCT findings. Eighty-three percent (20/24) were males, and the mean age was 47.7 years (SD: 49.2). The mean visual acuity at presentation was Snellen 20/57. On fundoscopy, 25.7% (9/35) of eyes had vitritis, whereas 22.8% (8/35) had placoid chorioretinal lesions. On OCT, 45.7% (16/35) of eyes had abnormal outer retina findings, most commonly disruption of the ellipsoid zone (EZ) and/or RPE excrescences. All patients were treated with penicillin or ceftriaxone, and final mean visual acuity was Snellen 20/29. CONCLUSIONS All 4 patients identified in the case series, and nearly half of patients with syphilitic optic neuropathy described in the literature had concurrent-specific outer retina abnormalities (disruption of EZ and/or placoid chorioretinitis in the form of RPE excrescences) seen on macular OCT. We recommend that clinicians obtain macular OCT for all patients presenting with undifferentiated optic neuropathy.
梅毒性视神经病变患者的黄斑光学相干断层扫描结果--病例系列和系统综述
背景梅毒是一种通过性途径或先天性获得的传染性疾病,可影响包括眼睛在内的多个器官系统。如果不及时诊断和治疗,会导致严重的发病率和死亡率。梅毒性视神经病变可能很难诊断,因为它可能与许多其他非梅毒性视神经受累病因相似,从而导致治疗延误。通过黄斑光学相干断层扫描(OCT)评估特定的视网膜外层异常可能有助于诊断眼梅毒。在病例系列研究中,我们对所有在 6 个月内因未分化视神经病变到一所三级大学附属神经眼科就诊并最终被诊断为梅毒性视神经病变的患者进行了回顾性病历审查。为了进行系统性研究,研究人员检索了 OVID MEDLINE、EMBASE 和 COCHRANE CENTRAL 数据库,以确定所有伴有黄斑 OCT 的梅毒性视神经病变病例。主要研究结果是OCT显示视网膜外层异常病例的患病率。年龄从 27 岁到 62 岁不等,其中 2 名患者为女性。经检查,视力从斯奈伦20/50到手部运动不等;所有患者都有视神经病变,黄斑OCT显示脉络膜视网膜炎,其特征是视网膜色素上皮(RPE)脱落。患者随后接受了葡萄膜炎检查,并被确诊为梅毒。他们接受了静脉青霉素治疗,随访发现视网膜外层外观有所改善。系统性回顾包括24例梅毒性视神经病变患者和35只眼睛,并报告了黄斑OCT检查结果。83%(20/24)的患者为男性,平均年龄为 47.7 岁(标准差:49.2)。就诊时的平均视力为斯奈伦20/57。眼底镜检查结果显示,25.7%(9/35)的眼睛患有玻璃体炎,22.8%(8/35)的眼睛患有脉络膜病变。在光学视网膜扫描(OCT)中,45.7%(16/35)的眼睛视网膜外层出现异常,最常见的是椭圆形区(EZ)破坏和/或RPE赘生物。结论本病例系列中发现的所有 4 名患者以及文献中描述的近一半梅毒性视神经病变患者在黄斑 OCT 上都同时出现了特异性视网膜外层异常(EZ 破坏和/或以 RPE 视网膜赘生物形式出现的胎盘状脉络膜炎)。我们建议临床医生为所有出现未分化视神经病变的患者进行黄斑 OCT 检查。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Journal of Neuro-Ophthalmology
Journal of Neuro-Ophthalmology 医学-临床神经学
CiteScore
2.80
自引率
13.80%
发文量
593
审稿时长
6-12 weeks
期刊介绍: The Journal of Neuro-Ophthalmology (JNO) is the official journal of the North American Neuro-Ophthalmology Society (NANOS). It is a quarterly, peer-reviewed journal that publishes original and commissioned articles related to neuro-ophthalmology.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信