虽经治疗但仍有梅毒眼部表现:一个病例系列。

IF 2.9 Q1 OPHTHALMOLOGY
Sairi Zhang, Kaersti L Rickels, Vignesh Krishnan, Sami H Uwaydat
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引用次数: 0

摘要

背景:几十年来,青霉素一直是治疗梅毒最有效的药物。梅毒性视网膜表现可能在治疗后持续存在,并导致视力问题。在本病例系列中,我们描述了三名梅毒患者因慢性炎症、治疗不彻底和再感染而导致后段表现持续存在:所有患者的最初治疗都是静脉注射青霉素14天。病例系列:建议所有患者的初始治疗均为静脉注射青霉素 14 天,在开始青霉素治疗 48 小时后再口服泼尼松。病例 1:一名 48 岁女性患者的视力逐渐下降,已持续两个月。眼底造影显示梅毒性外视网膜病变(SOR)、乳头炎和急性梅毒性后胎盘脉络膜视网膜病变(ASPPC)。治疗后,她出现了持续性囊样黄斑水肿(CME),并接受了玻璃体内曲安奈德注射和酮咯酸滴眼液治疗。病例 2:一名 24 岁男性患者突然视力下降两天。影像学检查显示,他患有 ASPPC、乳头炎和 SOR。他只接受了 10 天的青霉素静脉注射治疗。他的 SOR 持续存在,并接受了强力霉素和泼尼松治疗。病例 3:一名 52 岁的男性患者因眼部疼痛和视力下降就诊一周。影像学检查显示他患有 ASPPC 和乳头炎。治疗一个月后,他出现持续性乳头炎,于是重新开始口服泼尼松。一年后,他被发现复发了ASPPC,并被证实再次感染了梅毒,因此他接受了再次治疗:结论:在治疗持续性梅毒眼部表现时,我们建议检查青霉素治疗是否彻底,RPR滴度是否下降。结论:在治疗梅毒眼部顽固表现时,我们建议检查青霉素治疗是否彻底,RPR 滴度是否下降,如果两者都成立,则应对患眼进行抗炎治疗。导致视力预后不良的其他因素包括治疗延误、初始视力差、黄斑水肿和艾滋病病毒合并感染。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Persistent syphilitic ocular manifestations despite treatment: a case series.

Background: Penicillin has remained the most effective treatment for syphilis for several decades. Syphilitic retinal manifestations may persist following treatment and cause visual problems. In this case series, we describe three syphilis patients with persistent posterior segment manifestations due to chronic inflammation, incomplete treatment, and reinfection.

Case series: Recommended initial treatment for all patients was 14 days of intravenous penicillin. Oral prednisone was added 48 h after initiation of penicillin therapy. Case 1: A 48-year-old female presented with gradual vision loss for two months. Fundus imaging revealed syphilitic outer retinopathy (SOR), papillitis, and acute syphilitic posterior placoid chorioretinopathy (ASPPC). After treatment, she had persistent cystoid macular edema (CME) and was treated with intravitreal triamcinolone injections and ketorolac drops.

Case 2: A 24-year-old male presented with sudden vision loss for two days. On imaging, he had ASPPC, papillitis, and SOR. IV penicillin treatment was given for 10 days only. He had persistent SOR and was retreated with doxycycline and prednisone. Case 3: A 52-year-old male presented with eye pain and visual loss for one week. There was evidence of ASPPC and papillitis on imaging. One month after treatment, he had persistent papillitis and was restarted on oral prednisone. One year later, he was found to have recurrent ASPPC and was confirmed to be reinfected with syphilis, for which he was retreated.

Conclusion: When treating persistent syphilitic ocular manifestations, we recommend checking that the penicillin treatment was complete and the RPR titers are declining. If both hold true, then the affected eye should be treated with anti-inflammatory therapy. Other factors that contribute to poor visual prognosis include treatment delay, poor initial visual acuity, macular edema, and HIV coinfection.

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来源期刊
CiteScore
3.80
自引率
3.40%
发文量
39
审稿时长
13 weeks
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