Spectral domain optical coherence tomography findings in acute syphilitic posterior placoid chorioretinitis.
BACKGROUND
We describe the spectral domain optical coherence tomography (SD-OCT) findings in three patients with acute syphilitic posterior placoid chorioretinitis (ASPPC). The SD-OCT images demonstrate the pathologic changes in ASPPC with a high level of anatomic detail and may provide information about the pathophysiology of the disease.


RESULTS
We report a series of three consecutive patients seen at the Wilmer Eye Institute in 2012 and 2013 who presented with clinical and laboratory findings consistent with a diagnosis of unilateral ASPPC. Two of the three patients had HIV co-infection with good immune recovery. SD-OCT images from their initial (pre-treatment) presentation demonstrated thickening and hyperreflective nodularity of the choroid-retinal pigment epithelium (RPE) complex, with focal disruption of the overlying photoreceptor inner segment-outer segment junction in the areas corresponding to the retinal lesions seen on clinical examination. These changes improved with intravenous antibiotic treatment over a 3-month period of follow-up.


CONCLUSIONS
SD-OCT imaging in ASPPC demonstrates reversible, focal thickening, and nodularity of the RPE with disruption of the overlying photoreceptor inner segment-outer segment junction. We believe that these SD-OCT images support the concept that ASPPC involves an inflammatory process at the level of the choroid-RPE with resultant structural and functional changes in the retinal photoreceptors. Further study with OCT imaging may be helpful in better understanding this disease.
The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, 1800 Orleans St, Woods 476, Baltimore, MD 21287, USA. bryn@alumni.duke.edu.
Bryn M
BM
Burkholder
Theresa G
TG
Leung
Trucian A
TA
Ostheimer
Nicholas J
NJ
Butler
Jennifer E
JE
Thorne
James P
JP
Dunn