Purpose: 

To describe the appearance of Acute Syphilitic Posterior Placoid Chorioretinitis (ASPPC), a rare ocular manifestation of syphilis, on Spectral Domain-Optical Coherence Tomography (SD-OCT) both before and after treatment.

Methods: 

Ophthalmic examination, imaging studies, and SD-OCT scans of 30 eyes of 19 confirmed ASPPC cases were analyzed both at the time of presentation and at each follow-up visit. Standard treatment for neurosyphilis was given to each patient, including 4 million units of penicillin G administered intravenously every 4 hours for 10 days.

Results: 

Fundus examination and imaging studies were consistent with previous reports, and confirmed the diagnosis ASPPC. In 13 eyes (43.3%), baseline SD-OCT scans were performed within 1 to 2 days of presentation and revealed a small amount of subretinal fluid (SRF), disruption of the inner segment/outer segment (IS/OS) junction, and hyperreflective thickening of the retinal pigment epithelium (RPE). All 30 eyes were again scanned between day 7 and 9 following presentation and revealed loss of the IS/OS and OS/RPE bands, and irregular hyperreflectivity of the RPE with prominent, nodular elevations, but without SRF. Early disruption of the external limiting membrane (ELM) and punctate choroidal hyperreflectivity were seen in 1/30 (3.3%) and 14/30 (46.6%) eyes, respectively. Vision improved and the outer retinal abnormalities normalized in 28/30 eyes (93.3%) following treatment for neurosyphilis.

Conclusions: 

Patients with ASPPC show characteristic outer retinal abnormalities on SD-OCT imaging, including disruption of the IS/OS band, nodular thickening of the RPE with loss of the linear OS/RPE junction, and, in some cases, loss of the ELM, accumulation of SRF, and punctate hyperreflectivity in the choroid. Vision improved and these abnormalities reversed following treatment for neurosyphilis in the vast majority of patients.

Take home message: 

ASPPC is becoming a more frequent cause of posterior uveitis. It is important to make a clinical diagnosis, given that ASPPC can be cured with antibiotics, with near complete vision restoration.