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Related Experiment Video

Updated: Jul 4, 2025

Iris Fixation via External Pentagram Suturing

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Published on: May 5, 2022

Ocular syphilis masquerading as refractory retinal diseases.

Sung Who Park^1,2,3, Kye-Hyung Kim⁴, Han Jo Kwon^1,2

¹Department of Ophthalmology, School of Medicine, Pusan National University, Busan, South Korea.

BMC Infectious Diseases

|February 7, 2024

Summary

Ocular syphilis can mimic chronic macular diseases like neovascular age-related macular degeneration (AMD) and diabetic macular edema (DME). Early syphilis detection is crucial for effective treatment of these refractory retinal conditions.

Keywords:

Age related macular degeneration Choroidal neovascularization Diabetic macular edema Latent syphilis Ocular syphilis Syphilis

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Area of Science:

Ophthalmology
Infectious Diseases
Retinal Diseases

Background:

Syphilis can present with diverse ocular manifestations.
Ocular syphilis is often misdiagnosed, particularly when mimicking common chronic macular diseases.
Refractory cases of neovascular age-related macular degeneration (AMD) and diabetic macular edema (DME) warrant consideration of infectious etiologies.

Purpose of the Study:

To highlight two cases where syphilis mimicked chronic refractory macular diseases.
To emphasize the importance of considering syphilis in atypical presentations of retinal diseases.
To underscore the diagnostic utility of systemic evaluations and specific imaging in suspected ocular syphilis.

Main Methods:

Case report of two patients with refractory macular diseases (neovascular AMD and DME).
Patients underwent standard treatments including anti-vascular endothelial growth factor (VEGF) injections and surgery without improvement.
Systemic syphilis evaluation was performed, followed by intravenous penicillin treatment.

Main Results:

Both patients showed significant improvement in their macular conditions after treatment for syphilis.
The refractory macular diseases resolved with antimicrobial therapy, indicating syphilis as the underlying cause.
Indocyanine green angiography was noted as potentially helpful in diagnosing occult syphilis.

Conclusions:

Ocular syphilis can present as chronic, treatment-resistant macular diseases like DME and neovascular AMD.
Laboratory testing for syphilis should be considered in cases of refractory retinal diseases, not solely for uveitis.
Prompt diagnosis and treatment of syphilis are essential for managing these challenging ocular conditions.