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Br J Ophthalmol. 2019 Jan 30. pii: bjophthalmol-2018-313207. doi: 10.1136/bjophthalmol-2018-313207. [Epub ahead of print]

Current ophthalmology practice patterns for syphilitic uveitis.

Author information

1
Flinders University, Adelaide, South Australia, Australia.
2
University of São Paulo, Ribeirão Preto, Brazil.
3
Sadalla Amin Ghanem Eye Hospital, Joinville, Brazil.
4
Sydney University, Sydney, Australia.
5
Flinders University, Adelaide, South Australia, Australia justine.smith@flinders.edu.au.
#
Contributed equally

Abstract

BACKGROUND:

Syphilitic uveitis is re-emerging alongside the systemic infection. In July 2017, an international group of uveitis-specialised ophthalmologists formed the International Ocular Syphilis Study Group to define current practice patterns.

METHODS:

103 Study Group members based in 35 countries completed a 25-item questionnaire focused on case load, clinical presentations, use and interpretation of investigations, treatment and clinical indicators of poor prognosis.

RESULTS:

Members managed a mean of 6.1 patients with syphilitic uveitis in clinics that averaged 707 annual cases of uveitis (0.9%); 53.2% reported increasing numbers over the past decade. Patients presented to more members (40.2%) during secondary syphilis. Uveitis was usually posterior (60.8%) or pan (22.5%); complications included optic neuropathy, macular oedema and posterior synechiae. All members diagnosed syphilitic uveitis using serological tests (simultaneous or sequential testing algorithms), and 97.0% routinely checked for HIV co-infection. Cerebrospinal fluid (CSF) analysis was ordered by 90.2% of members, and 92.7% took uveitis plus Venereal Disease Research Laboratory test (VDRL) or fluorescent treponemal antibody absorption test (FTA-ABS) to indicate neurosyphilis. Patients were commonly co-managed with infectious disease physicians, and treated with penicillin for at least 10-14 days, plus corticosteroid. Features predicting poor outcome included optic neuropathy (86.3%) and initial misdiagnosis (63.7%). Reasons for delayed diagnosis were often practitioner-related. 82.5% of members tested every patient they managed with uveitis for syphilis.

CONCLUSION:

This comprehensive report by an international group of uveitis-specialised ophthalmologists provides a current approach for the management of syphilitic uveitis.

KEYWORDS:

eye, syphilis, uveitis; infection; inflammation

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