Ultra-wide-field fundus autofluorescence and spectral-domain optical coherence tomography findings in syphilitic outer retinitis

BACKGROUND AND OBJECTIVE: To determine the ultra-wide-field fundus autofluorescence (UWF-FAF) and optical coherence tomography (OCT) features of syphilitic outer retinopathy (SOR). PATIENTS AND METHODS: Retrospective chart review. RESULTS: Three patients with SOR were investigated. Treatment with parenteral penicillin led to improvement of outer retinopathy, visual acuity, and symptoms. UWFFAF showed speckled hyperautofluorescence, hypoautofluorescence, and normal autofluorescence, similar to what has been described as a trizonal pattern in acute zonal occult outer retinopathy (AZOOR) in the chronic case of SOR, but with hyperautofluorescent areas in the two acute cases. OCT showed disruption of the photoreceptor outer segment ellipsoid zone and external limiting membrane, which improved after penicillin treatment, and corresponded to normalization of the hyperautofluorescent areas on UWF-FAF. There was irregularity and nodular thickening of retinal pigment epithelium on OCT in areas of mottled hyperautofluorescence. CONCLUSION: SOR can present similarly to AZOOR on UWFFAF and should be highly suspected in cases presenting like AZOOR.