Near Infrared Reflectance Imaging Changes in Acute Syphilitic Outer Retinitis.

Purpose: To examine near infrared reflectance (NIR) imaging in acute syphilitic outer retinitis.

Design: Retrospective case series.

Subjects: Patients diagnosed with ocular syphilis from 2015 to 2024 at Wake Forest Baptist Hospital.

Methods: Two authors independently graded NIR images for notable imaging characteristics with joint review with a third grader for disagreements.

Main Outcome Measures: Near infrared reflectance images were graded based on presence of white dot lesions, granular pattern (defined as a fine pattern of hyperreflective dots), geographic reflectivity changes (defined as an area of hyporeflectivity delineated by a demarcation line), and hyporeflectivity changes due to either subretinal fluid or pigment epithelial detachments.

Results: Thirty-nine eyes from 22 ocular syphilis patients with available NIR images were included in the study. The most common findings were white dots (79.5%), granular pattern (56.4%), and geographic reflectivity changes (38.5%). A new finding was a hyperreflective patch on NIR that correlated to a hyperreflective layer above the ellipsoid zone (EZ) on OCT. After penicillin therapy, this area of hyperreflectivity was replaced with white dots on NIR that correlated with new subretinal hyperreflective foci on OCT.

Conclusions: Near infrared reflectance imaging in ocular syphilis can highlight subtle retinal changes, including changes in the EZ layer and subretinal deposits. Understanding NIR findings in ocular syphilis can help make early diagnoses and monitor treatment responses.

Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.