Treatment Outcomes in Patients with Acute Syphilitic Posterior Placoid Chorioretinitis

To describe clinical outcomes in a large cohort with acute syphilitic posterior placoid chorioretinitis (ASPPC).

Clinical records of patients with ASPPC, diagnosed between 2012 and 2023, were retrospectively reviewed. Confirmation of syphilis diagnosis required positive serological testing, except in human immunodeficiency virus (HIV)-positive patients. Data collected included demographics and HIV status, baseline and final best corrected visual acuity (BCVA), optical coherence tomography (OCT) and fundus autofluorescence (FAF) imaging at baseline, antimicrobial treatment, and oral corticosteroid use.

A total of thirty-five patients (31 male) were included. Recognition of ASPPC led to a diagnosis of syphilis in 32 (91.4%) patients. Eight (22.9%) patients were HIV-positive. A total of fourteen (40.0%) patients presented with bilateral ASPPC. Concurrent retinitis was identified in 4 (8.2%) of 49 affected eyes. All patients manifested typical ASPPC changes on OCT imaging (ellipsoid zone disruption and retinal pigment epithelial thickening and nodular elevations) with corresponding FAF alterations. All received oral prednisolone for 3 days and antimicrobial treatment; a longer course of oral prednisolone was prescribed in 32 (91.4%) patients with median treatment duration of 11 weeks (range 2-65). Median follow-up was 19.5 weeks (range 2-173). Following treatment, mean (±standard deviation) LogMAR BCVA improved from +0.70 (±0.78) to +0.21 (±0.41) (p < 0.0001), whereas anatomical recovery was evident in 37 (84.1%) of 44 eyes with available imaging at final follow-up.

In the largest cohort of patients with ASPPC reported to date, combination systemic antimicrobial and corticosteroid treatment was associated with favourable outcomes. Using systemic steroids alongside antibiotics in patients with ASPPC is safe.