以眼后节表现为主的梅毒性眼病临床分析

Clinical features of ocular posterior segment syphilis

目的分析首诊眼科以眼后节表现为主的梅毒性眼病的临床特征。方法回顾分析2014年4月~2019年3月首诊复旦大学附属金山医院眼科并经临床及梅毒血清学检查确诊的12例(21眼)梅毒性眼病患者的临床资料。其中男性7例、女性5例,年龄33~69岁,平均(49.58±11.33)岁;出现症状到确诊时间为4 d~2年;单眼发病3例,双眼发病9例。人类免疫缺陷病毒(HIV)检测均为阴性。结果眼部表现为脉络膜视网膜炎8例(13眼),全葡萄膜炎、视神经视网膜炎、缺血性视神经病变、视网膜血管炎各1例(均为双眼)。荧光素眼底血管造影(FFA)显示所有患者造影晚期视盘荧光着染或强荧光渗漏,边界模糊;19眼视网膜血管节段性荧光渗漏及晚期管壁着染;其余表现有脉络膜斑驳状强荧光、黄斑区荧光积存等。光学相干层析成像(OCT)显示16眼黄斑区外界膜和椭圆体带断裂或缺失,视网膜色素上皮(RPE)层不规则或颗粒状高反射。经正规驱梅治疗,所有患者眼部炎症消退,除1眼视力无改善外,其余视力均提高。结论梅毒性眼病表现多样化,在眼后节主要表现为脉络膜视网膜炎,FFA及OCT有一定的影像学特征。早期诊断、及时治疗,可以获得较好的预后。

Objective To investigate the clinical features of ocular posterior segment syphilis.Methods The clinical data of 12 patients(21 eyes)with active ocular syphilis were collected retrospectively.The diagnosis was first made in the Department of Ophthalmology,Jinshan Hospital of Fudan University from April 2014 to March 2019 and confirmed by clinical and syphilis serological examination.Among all the patients,there were 7 males and 5 females,aged from 33 to 69 years,with an average of 49.58±11.33 years.The time from onset of symptoms to diagnosis was 4 days to 2 years,with 3 cases of monocular and 9 cases of bilateral onset.Human immunodeficiency virus(HIV)test was negative for all cases.Results The major ocular manifestations included chorioretinitis(8 cases,13 eyes),panuveitis(1 case,2 eyes),neuroretinitis(1 case,2 eyes),ischemic optic neuropathy(1 case,2 eyes),and retinal vasculitis(1 case,2 eyes).Fundus fluorescein angiography(FFA)showed optic disc staining or hyperfluorescence leakage in all cases,and vascular leakages in 19 eyes.Others included choroidal mottled hyperfluorescence,staining pool in the macular.Optical coherence tomography(OCT)showed the external limiting membrane and the ellipsoid zone were broken or missing in 16 eyes,with irregular or granular hyperreflectivity of the retinal pigment epithelium(RPE)layer.After standard anti-syphilitic treatment,ocular inflammation of all patients was subsided,and the visual acuity improved except for 1 eye.Conclusions Ocular syphilis often presents with a variety of manifestations,and the major manifestation of ocular posterior segment syphilis is chorioretinitis.FFA and OCT show some imaging characteristics.Early diagnosis and timely treatment can get a better prognosis.