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The study looked at 24 patients (20 males, four females) with serological evidence of syphilitic infection who presented to a tertiary ophthalmic centre. Ocular involvement was the first manifestation of syphilitic disease in 96% and Human Immunodeficiency Virus (HIV) seropositivity was found in 29% of the cases. The most frequent ocular manifestation was posterior uveitis and vitreous inflammation was present in 14 patients (58%), and always associated with other ocular manifestations. Within posterior uveitis presentations, chorioretinitis was the most frequent presentation, with bilateral presentations in three patients. Anterior uveitis was noted in six patients (25%), with bilateral involvement in two cases, panuveitis in seven patients (29%); bilateral in two cases. The most frequent complications were exudative retinal detachment in two eyes of two patients (8%) and macular pucker. Papillitis at onset was associated with better visual outcomes following anti-syphilitic treatment. Posterior uveitis at onset and HIV seropositivity were negative prognostic factors for visual outcome. HIV-positive patients showed more severe and frequent bilateral course of ocular involvement in syphilis. The authors highlight that their study follows the global increase in incidence of syphilis noted in the previous 10 years. They recommend that the ophthalmologist should suspect syphilis in patients with uveitis or optic neuropathy associated with high-risk sexual behaviour and / or HIV, or in patients with posterior placoid chorioretinitis, necrotising retinitis, or interstitial keratitis.

Clinical features of ocular syphilis: a retrospective clinical study in an Italian referral centre.
Mallone F, Pirraglia MP, Bruscolini A, et al.
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Su Young

Moorfields Eye Hospital NHS Trust, London, UK.

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