Bilateral retrocorneal hyaline scrolls secondary to asymptomatic congenital syphilis: A case report

BACKGROUND Retrocorneal hyaline scrolls are a rare phenomenon.We report a case of bilateral retrocorneal hyaline scrolls that were likely induced by asymptomatic congenital syphilis.CASE SUMMARY A 71-year-old woman presented with blurred vision due to cataracts.Slit-lamp microscopy revealed bilateral hyaline scrolls with a dichotomous branching pattern extending to the anterior chamber or rods attaching to the rough posterior surface of the cornea.The patient was positive for syphilis-specific antibodies,with no ocular or systemic evidence of congenital or acquired syphilis.Binocular cataract,retrocorneal scroll,and corneal endothelial gutta were considered.The scroll of the right eye was removed during cataract surgery and further observed using hematoxylin–eosin staining and scanning electron microscopy.The cornea of the right eye remained transparent,and the residual scroll seemed stable,however,the corneal endothelial density declined at 13 mo after surgery.In vivo confocal microscopy revealed coalescence of corneal guttae at the level of the corneal endothelium or adhesion to the posterior surface of the endothelium,with enlarged endothelial cells in both eyes.Activated keratocytes in the stroma and a highly reflective acellular structure at the level of the Descemet’s membrane were observed.The removed scroll had a cartilage-like hardness and a circularly arranged fiber-like acellular structure.CONCLUSION Occult congenital syphilis could induce corneal endothelial gutta and theformation of retrocorneal scrolls without other signs of ocular syphilis.

Adult female syphilis prevalence,congenital syphilis case incidence and adverse birth outcomes,Mongolia 2000e2016:Estimates using the Spectrum STI tool

Introduction:Mongolia's health ministry prioritizes control of Sexually Transmitted Infections,including syphilis screening and treatment in antenatal care(ANC).Methods:Adult syphilis prevalence trends were fitted using the Spectrum-STI estimation tool,using data from ANC surveys and routine screening over 1997e2016.Estimates were combined with programmatic data to estimate numbers of treated and untreated pregnant women with syphilis and associated incidence congenital syphilis(CS)and CS-attributable adverse birth outcomes(ABO),which we compared with CS case reports.Results:Syphilis prevalence in pregnant women was estimated at 1.7%in 2000 and 3.0%in 2016.We estimated 652 CS cases,of which 410 ABO,in 2016.Far larger,annually increasing numbers of CS cases and ABO were estimated to have been prevented:1654 cases,of which 789 ABO in 2016
thanks to increasing coverages of ANC(99%in 2016),ANC-based screening(97%in 2016)and treatment of women diagnosed(81%in 2016).The 42 CS cases reported nationally over 2016(liveborn infants only)represented 27%of liveborn infants with clinical CS,but only 7%of estimated CS cases among women found syphilis-infected in ANC,and 6%of all estimated CS cases including those born to women with undiagnosed syphilis.Discussion/Conclusion:Mongolia's ANC-based syphilis screening program is reducing CS,but maternal prevalence remains high.To eliminate CS(target:<50 cases per 100,000 live births),Mongolia should strengthen ANC services,limiting losses during referral for treatment,and under-diagnosis of CS including still-births and neonatal deaths,and expand syphilis screening and prevention programs.