Short-Term Treatment of Syphilitic Uveitis With Intravitreal Ceftazidime

To review the clinical outcomes of patients with ocular syphilis that were treated in the short-term with intravitreal ceftazidime when definitive treatment with penicillin was delayed due to a variety of extenuating circumstances.

Retrospective interventional case series.

A total of 45 patients diagnosed and treated for syphilitic posterior or panuveitis between January 2, 2019, and July 1, 2024, at a tertiary referral private practice. Of these, 10 patients (n = 14 eyes) were treated short-term with intravitreal ceftazidime before initiating penicillin therapy. Three of these patients are presented as cases to highlight factors that might contribute to treatment delays.

One or more intravitreal injections of 2.25 mg/0.1 mL ceftazidime.

Visual acuity, inflammatory grade based on Standardization for Uveitis Nomenclature criteria, causes for delay in systemic antibiotic treatment, changes in aqueous bacterial polymerase chain reaction (PCR) following ceftazidime administration, changes in multimodal imaging.

Following treatment with intravitreal ceftazidime and prior to penicillin treatment, all eyes (n = 14) had improved inflammatory parameters. Of the 9 eyes with measurable baseline Snellen vision, all improved by an average of 5.4 lines (range = +1 to 9). In the two eyes of patients for whom aqueous bacterial PCR was initially positive for Treponema pallidum, subsequent PCR was negative prior to initiation of penicillin. All patients eventually received definitive systemic antibiotic therapy and had resolution of their syphilitic uveitis.

Patients experienced improvements in visual acuity and inflammation when treated with intravitreal ceftazidime before the initiation of penicillin, suggesting that ceftazidime could be leveraged in care for those with syphilitic uveitis. With the increasing number of cases of syphilis nationally over the last decade, combined with the growing shortages of penicillin, it is vital to consider adjunctive therapies for treatment of syphilitic uveitis to help improve visual outcomes.