Prognostic Factors in Syphilitic Uveitis

Ophthalmology. 2017 Dec;124(12):1808-1816. doi: 10.1016/j.ophtha.2017.06.003. Epub 2017 Aug 2.

Abstract

Purpose: To identify predictors of treatment success in syphilitic uveitis (SU).

Design: Retrospective multicentric analysis of patients treated for SU.

Participants: A total of 95 eyes (66 patients, mean [standard deviation] aged 49 [12.5] years, 31 [47%] of whom were human immunodeficiency virus [HIV]+) were analyzed.

Methods: Activity of SU was assessed at 1 week and 1 month after treatment onset, and at last follow-up. Improvement was defined by a ≥2-step decrease of both anterior chamber and vitreous haze inflammation levels, and by the size reduction in chorioretinal lesions.

Main outcome measures: Recovery was defined as the resolution of inflammation in all anatomic structures at 1 month.

Results: Panuveitis and posterior uveitis were the most frequent findings. Inflammatory parameters were higher in HIV+ patients. Recovery was reported in 65% and 85% of eyes at 1 month and at last follow-up, respectively. In multivariate analysis, after adjusting for initial best-corrected visual acuity and the antimicrobial treatment regimen, clinical improvement at 1 week (corrected risk ratios [cRR], 3.5 [2.3-3.8]; P = 0.001) was predictive of recovery at 1 month, whereas the use of periocular dexamethasone injections (cRR, 0.05 [0.02-0.6]; P = 0.01) and methylprednisolone pulses negatively affected the outcomes of eyes.

Conclusions: Early improvement is the strongest predictor of ophthalmological recovery in SU.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-Bacterial Agents / therapeutic use*
  • Azithromycin / therapeutic use
  • Doxycycline / therapeutic use
  • Eye Infections, Bacterial / diagnosis
  • Eye Infections, Bacterial / drug therapy*
  • Eye Infections, Bacterial / microbiology
  • Female
  • Fluorescent Treponemal Antibody-Absorption Test
  • Follow-Up Studies
  • HIV Seropositivity
  • Humans
  • Male
  • Middle Aged
  • Penicillin G Benzathine / therapeutic use
  • Polymerase Chain Reaction
  • Prognosis
  • Retrospective Studies
  • Sulfadiazine / therapeutic use
  • Syphilis / diagnosis
  • Syphilis / drug therapy*
  • Syphilis / microbiology
  • Syphilis Serodiagnosis
  • Uveitis / diagnosis
  • Uveitis / drug therapy*
  • Uveitis / microbiology
  • Visual Acuity / physiology

Substances

  • Anti-Bacterial Agents
  • Sulfadiazine
  • Azithromycin
  • Doxycycline
  • Penicillin G Benzathine