En Face Optical Coherence Tomography and Optical Coherence Tomography Angiography for the Diagnosis and Monitoring of Syphilitic Posterior Placoid Chorioretinopathy

Abstract

Purpose: To describe a case of syphilitic posterior placoid chorioretinopathy, a rare ocular manifestation of syphilis requiring prompt diagnosis and treatment. Methods: A single case was evaluated. Results: Multimodal imaging including spectral-domain optical coherence tomography (SD-OCT), en face OCT, and OCT angiography (OCTA), were used to confirm a diagnosis in a patient presenting with symptoms of syphilitic posterior placoid chorioretinopathy. SD-OCT showed nodular hyperreflective thickening of the retinal pigment epithelium (RPE), an attenuated ellipsoid zone, loss of the outer segment/RPE junction, and trace hyperreflective vitreous material. En face OCT showed hyperreflective lesions at the avascular complex layer, and flow voids suggestive of nonperfusion within the choriocapillaris were seen on OCTA. SDOCT showed resolution of disease after 1 week of treatment with penicillin, but en face OCT and OCTA findings persisted for 1 month before finally resolving. Conclusions: En face OCT and OCTA enable the early detection of placoid lesions and microvascular changes commonly seen in syphilitic posterior placoid chorioretinopathy, allowing for the development of an appropriate treatment plan.