探讨神经梅毒合并视神经萎缩患者的眼底特征。

收集首都医科大学附属北京地坛医院眼科于2013年8月至2019年5月收治的8例神经梅毒合并视神经萎缩患者的临床资料。对入组患者进行梅毒血清学、脑脊液检测及眼科检查[包括视力，裂隙灯，光学相干断层扫描（OCT）测量视盘周围视网膜神经纤维层（RNFL）厚度，标准彩色眼底照相，动态视野并进行眼底特征分析]。将患者视力转换为logMar视力后分析，梅毒甲苯胺红不加热血清试验（TRUST）滴度按照以2为底数的对数换算。采用Spearman相关性分析探讨患者视力与血液和脑脊液TRUST滴度的相关性。

8例患者均为男性，年龄34~59岁，平均年龄（46.00 ± 8.79）岁。就诊时平均视力为光感~0.6，病程3个月~2年。8例患者（16眼）视盘周围RNFL平均厚度显著下降（28.5~70.33 μm），下降比例为33.39%~73.01%。其中4眼RNFL厚度下降比例为30%~50%，12眼下降比例均> 50%。RNFL鼻侧平均厚度下降最多，其次为颞下、鼻上、鼻下、颞上和颞侧，下降比例分别为60.24%、58.30%、54.48%、51.76%、51.26%和50.00%。8例患者（16眼）中有2例（4眼）眼底彩相检查表现为双眼视盘色淡，其余6例患者（12眼）均表现为双眼视盘苍白，视网膜血管变细。8例患者中仅3例可配合视野检查，且均有不同程度视野缺损。8例患者血清TRUST滴度为1︰4~1︰256，脑脊液TRUST滴度为1︰1~1︰4。8例患者血清梅毒螺旋体明胶凝集试验（TPPA）（+），脑脊液TPPA（+）。Spearman相关性分析发现神经梅毒患者视力损害程度与血清TRUST滴度（r = 0.075、P = 0.86）和脑脊液TRUST滴度（r = 0.183、P = 0.66）无显著相关性。

神经梅毒合并视神经萎缩患者的眼底可表现为视盘色淡或苍白，视网膜血管变细；视盘周围RNFL厚度降低，视野缺损，可表现为环形相对暗点或绝对暗点，视野丢失严重者仅存颞上方或颞下方视岛。如不及时治疗，最终可导致视神经萎缩。

To investigate the characteristics of fundus lesions of patients with neurosyphilis and optic nerve atrophy.

Clinical data of 8 patients with neurosyphilis and optic nerve atrophy admitted in Beijing Ditan Hospital, Capital Medical University from August 2013 to May 2019 were analyzed. All patients underwent serological, cerebrospinal fluid examination and ophthalmic examination which included visual acuity, slit lamp, optical coherence tomography (OCT) measurement of retinal nerve fiber layer (RNFL) thickness around the optic disc, standard color fundus photography, dynamic visual field and fundus characteristics analysis. Visual acuity was converted to the logarithm of the minimum angle of resolution (logMar) for statistical analysis, the syphilis toluidine red non-heated serum assay (TRUST) titers were converted as logarithmic at base 2. The correlation of visual acuity and TRUST titers of blood and CSF were explored by Spearman correlation analysis.

All eight patients were male, with an average age of (46.00 ± 8.79) years old (ranging from 34 to 59 years old). The visual acuity ranged from light sense to 0.6, the course of disease ranged from 3 months to 2 years. The thickness of RNFL decreased significantly in 8 patients (16 eyes), ranging from 28.5 μm to 70.33 μm, with a decrease rate of 33.39%-73.01%, among which, RNFL thickness decreased 30%-50% in 4 eyes and higher than 50% in 12 eyes. Nasal RNFL average thickness decreased the most, following by infratemporal, supranasal, inferonasal, supratemporal and temporal, with the decrease rates of 60.24%, 58.30%, 54.48%, 51.76%, 51.26% and 50%, respectively. Among the 8 patients (16 eyes), 2 patients (4 eyes) showed light optic disc, while the other 6 patients (12 eyes) showed pale optic disc in both eyes. All patients presented retinal vascular thinning. Only 3 patients underwent visual field examination, who had different degrees of visual field defect in 6 eyes. The TRUST titer were 1︰4-1︰256 in 8 patients, while the CSF TRUST titer were 1︰1-1︰4. Serum and CSF treponema pallidus gelatin agglutination test (TPPA) were positive in all 8 patients. Spearman’s rank correlation analysis showed that the degree of visual impairment in neurosyphilis patients were not positively correlated with TRUST titer in serum (r = 0.075, P = 0.86) and CSF (r = 0.183, P = 0.66), without significant differences.

The fundus of patients with neurosyphilis and optic nerve atrophy showed light or pale optic disk and shrinked retinal blood vessels. The thickness of RNFL around optic nerve decreased, and the visual field lacked, which could be manifested as the annular relative dark point or the absolute dark point, and only the superior or inferior temporal optic islands were left with severe visual field loss. Without timely treatment, it would eventually lead to optic nerve atrophy.