Name

Pourquoi la placoide syphilitique reste hypo fluorescente à la phase tardive de l'angiographie au vert d'indocyanine

Acute Syphilitic Posterior Placoid Chorioretinitis (ASPPC) is a rare form of the large spectrum syphilis. Debate has recently been relaunched on the primary harmed structure in ASPPC, either the choriocapillaris or the RPE. Our purpose is to add new insight to the reflexion about the lesions localization in ASPPC

This is a retrospective observational case studies of patients diagnosed with acute syphilitic posterior placoid uveitis. We reviewed uveitis medical records in a tertiary recruitment center between 2012 and December 2015, out of the patients diagnosed with uveitis related to Syphilis infection, we selected Posterior Placoid lesions with acquired late phase Indocyanine Green Angiography (ICGA). We included 15 eyes of 12 patients.

Fifteen eyes were included in the study, and all presented with hypofluorescence plaques at the late ICGA phase. OCT-Angiography was realized in 4 eyes and showed flow voids at the level of choriocapillaris in 1 eye. Placoid lesions delimitated in Blue Autofluorescence (BAF) presented the same dimensions as on late phase ICGA. SD-OCT features were Ellipsoid zone disruptions, Outer retinal disruptions, and RPE elevations (called clumps). 

In our cohort, ASPPC seemed to primarily harm the RPE with secondary outer retinal lesions. However it is possible that different mechanisms are coexisting in the syphilis placoid chorioretinitis with RPE and/or choriocapillaris involvement at the same time and/or delayed but probably transient as many patients recover good visual acuity after appropriate treatment.

Acute syphilitic posterior placoid chorioretinitis seems to involve primarily the RPE rather than the choriocapillaris.