ANTI-VEGF THERAPHY FOR CHOROIDAL NEOVASCULARIZATION IN OCULAR SYPHILIS: A CASE REPORT
Nurul Ibtisam M., Sangeeta K., Noram M.S. & Norshamsiah M.D.
abstract
Choroidal neovascularization (CNV) secondary to Ocular syphilis is a rare manifestation of the disease. We report a case of a 52-year-old man who presented with floaters and reduced vision in the left eye for five days. Examination revealed vitritis with grayish macular lesion bilaterally. Macular optical Coherence Tomography (OCT) showed fibrinous pigment epithelial detachment and fundus fluorescein angiography (FFA) showed active leakage suggestive of active CNV. Blood investigations revealed positive VDRL titre. The patient was diagnosed as bilateral ocular syphilis with CNV and treated with intravenous Penicillin alongside topical and systemic corticosteroids. Intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection to both eyes resulted in significant visual recovery.
references
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6. Schadlu, R., Blinder, K.J., Shah, G.K., Holekamp, N.M., Thomas, M.A., Grand, M.G., Engelbrecht, N.E., Apte, R.S., Joseph, D.P., Prasad, A.G. and Smith, B.T., 2008. Intravitreal bevacizumab for choroidal neovascularization in ocular histoplasmosis. American journal of ophthalmology, 145(5), pp.875-878.
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8. Shah, N.J. and Shah, U.N., 2011. Intravitreal ranibizumab for the treatment of choroidal neovascularization secondary to ocular toxoplasmosis. Indian Journal of Ophthalmology, 59(4), p.318.
9. Agarwal, A., Invernizzi, A., Singh, R.B., Foulsham, W., Aggarwal, K., Handa, S., Agrawal, R., Pavesio, C. and Gupta, V., 2018. An update on inflammatory choroidal neovascularization: epidemiology, multimodal imaging, and management. Journal of Ophthalmic Inflammation and Infection, 8, pp.1-18.
10. Kim, E.L., Rodger, D.C. and Rao, N.A., 2017. Choroidal neovascularization secondary to tuberculosis: presentation and management. American Journal of Ophthalmology Case Reports, 5, pp.124-129.
11. Wai, K.M., Gong, D., Rodriguez, M., Cunningham Jr, E.T., Vavvas, D.G. and Eliott, D., 2022. Acute Syphilitic Posterior Placoid Chorioretinitis With Subfoveal Choroidal Neovascularization Managed With Anti-VEGF Therapy. Journal of vitreoretinal diseases, 6(3), pp.246-250.
12. Vieira, R. and Furtado, M.J., 2022. Long-Term Bilateral Poorly Treated Acute Syphilitic Posterior Placoid Chorioretinitis Complicated with Choroidal Neovascularization: A Case Report. International Medical Case Reports Journal, pp.543-549.
13. Schimansky, S. and Burke, T., Case report: Bilateral choroidal neovascular membranes in a patient with a delayed diagnosis of acute syphilitic posterior placoid chorioretinopathy. Frontiers in Ophthalmology, p.29.
2. Lee, S.Y., Cheng, V., Rodger, D. and Rao, N., 2015. Clinical and laboratory characteristics of ocular syphilis: a new face in the era of HIV co-infection. Journal of Ophthalmic Inflammation and Infection, 5, pp.1-7.
3. Giuffrè, C., Marchese, A., Cicinelli, M.V., Miserocchi, E., Querques, G., Bandello, F. and Modorati, G., 2022. Multimodal imaging and treatment of syphilitic choroidal neovascularization. Retinal Cases and Brief Reports, 16(1), pp.85-88.
4. Velayuthan, R.D., 2020. An epidemiological study of syphilis and predictors of treatment failure in University Malaya Medical Center. The Medical Journal of Malaysia, pp.199-203.
5. Świerczyńska, M.P., Sedlak, L.S., Nowak, M.A. and Wyględowska-Promieńska, D., 2021. Choroidal neovascularization secondary to ocular syphilis. Romanian Journal of Ophthalmology, 65(4), p.406.
6. Schadlu, R., Blinder, K.J., Shah, G.K., Holekamp, N.M., Thomas, M.A., Grand, M.G., Engelbrecht, N.E., Apte, R.S., Joseph, D.P., Prasad, A.G. and Smith, B.T., 2008. Intravitreal bevacizumab for choroidal neovascularization in ocular histoplasmosis. American journal of ophthalmology, 145(5), pp.875-878.
7. Ben Yahia, S., Herbort, C.P., Jenzeri, S., Hmidi, K., Attia, S., Messaoud, R. and Khairallah, M., 2008. Intravitreal bevacizumab (Avastin) as primary and rescue treatment for choroidal neovascularization secondary to ocular toxoplasmosis. International Ophthalmology, 28, pp.311-316.
8. Shah, N.J. and Shah, U.N., 2011. Intravitreal ranibizumab for the treatment of choroidal neovascularization secondary to ocular toxoplasmosis. Indian Journal of Ophthalmology, 59(4), p.318.
9. Agarwal, A., Invernizzi, A., Singh, R.B., Foulsham, W., Aggarwal, K., Handa, S., Agrawal, R., Pavesio, C. and Gupta, V., 2018. An update on inflammatory choroidal neovascularization: epidemiology, multimodal imaging, and management. Journal of Ophthalmic Inflammation and Infection, 8, pp.1-18.
10. Kim, E.L., Rodger, D.C. and Rao, N.A., 2017. Choroidal neovascularization secondary to tuberculosis: presentation and management. American Journal of Ophthalmology Case Reports, 5, pp.124-129.
11. Wai, K.M., Gong, D., Rodriguez, M., Cunningham Jr, E.T., Vavvas, D.G. and Eliott, D., 2022. Acute Syphilitic Posterior Placoid Chorioretinitis With Subfoveal Choroidal Neovascularization Managed With Anti-VEGF Therapy. Journal of vitreoretinal diseases, 6(3), pp.246-250.
12. Vieira, R. and Furtado, M.J., 2022. Long-Term Bilateral Poorly Treated Acute Syphilitic Posterior Placoid Chorioretinitis Complicated with Choroidal Neovascularization: A Case Report. International Medical Case Reports Journal, pp.543-549.
13. Schimansky, S. and Burke, T., Case report: Bilateral choroidal neovascular membranes in a patient with a delayed diagnosis of acute syphilitic posterior placoid chorioretinopathy. Frontiers in Ophthalmology, p.29.