Affiliations: Department of Experimental Ophthalmology, University
Eye Hospital, University of Münster, Münster, Germany
Note: [] Corresponding author: S. Thanos, Department of Experimental
Ophthalmology, School of Medicine, University of Münster,
Domagkstraşe 15, D-48149 Münster, Germany. Tel.: +49 251 8356915;
Fax: +49 251 8356916; E-mail: solon@uni.muenster.de
Abstract: Background: Infection with Treponema pallidum causes multiorgan
manifestations including isolated optic nerve involvement at any stage of the
disease. This is of particular interest for resulting in severe visual
impairment, which is reversible if treated adequately. Purpose: To review clinical and diagnostic findings in
patients with optic nerve affection in neurosyphilis and to focus on the visual
outcome after administering adjunctive cortisone to the standard therapy
regimes with penicillin G. Methods/Patients: The review is based on a retrospective case
serial of 4 patients (three males: mean age 40years, range 37–42 years; one
female: mean age 62years) with optic nerve involvement in neurosyphilis treated
in our hospital, and on a literature review of recent publications. Patients
were treated with systemic penicillin either with or without adjunctive
cortisone. The major outcome measure of therapy was improvement of visual
acuity. Results: Visual outcome in our case serial showed total
restoration if cortisone was also administered. The bibliographic survey, which
was based on 60 patients, also revealed a better improvement of vision when
antibiotic medication was combined with cortisone. Conclusions: The data show that the causal therapy of choice
is undoubtedly penicillin G, with adjunctive steroids playing a crucial role in
improvement of optic nerve functional outcome. Physicians should consider the
use of cortisone in SON whenever clinically harmless, although prospective
randomized multicenter studies are required to support this recommendation.
