The Rise of Syphilitic Placoid Chorioretinitis: A Literature Review with Data from 286 Published Cases.

Purpose: To investigate all published reports of acute syphilitic posterior placoid chorioretinitis (ASPPC) and to analyse demographic, clinical and management features to clarify trends in presentation, diagnosis and outcome.

Methods: A comprehensive review of literature relating to ASPPC including examples within published series of ocular syphilis, case series limited to ASPPC and case reports.

Results: A total of 128 publications included 286 patients with 387 eyes affected by ASPPC. This is increasing in frequency and since 2020 accounts for 26% of ocular syphilis in case series; it appears most common in countries where the predominant Treponema pallidum subclade is SS14 Omega. Visual symptoms were the first in 81%. The mean age at onset was 47.0 yrs (range 23-81), 84% were male and these were more likely to be men who had sex with men (MSM)(p = 0.001). Risk was not increased by HIV positivity. Recovery to LogMAR 0.3 or better was achieved in 85%.

Conclusions: Men are particularly affected by ASPPC, especially MSM. It is associated with otosyphilis. Optic nerve involvement is less common in ASPPC, compared to other forms of ocular syphilis. Visual outcomes were very good unless treatment onset was delayed and were equally good for HIV+ and HIV- patients; IV penicillin, IM penicillin and IV ceftriaxone were equally effective. Data quality on systemic steroid usage was too poor to permit analysis. The aetiology of ASPPC remains unknown but geographical disparity supports the possibility of an association between ASPPC and particular treponemal subclade(s).