Clinical Features and Risk Factors for Chronic Syphilitic Uveitis

To investigate clinical features and identify risk factors associated with chronic syphilitic uveitis. A retrospective chart review was performed of patients diagnosed with syphilitic uveitis at the University of Illinois Hospital and the University of Nebraska Medical Center between January 2015 and July 2024. Patients aged 18+ with syphilitic uveitis and at least 3 post-penicillin treatment follow-ups were included. Chronic uveitis was defined as inflammation persisting longer than 3 months or recurring within 3 months post-treatment. Of 74 patients with syphilitic uveitis (mean age 46.7 years, 71.6% male), 54 patients had sufficient follow-up. Of these patients, 20 (37%) patients developed chronic uveitis, with panuveitis being the most common presentation (50%). The chronic group had significantly longer mean symptom duration before treatment (p = 0.006), worse visual acuity at diagnosis (p = 0.023), and higher rate of cystoid macular edema (CME) at diagnosis (p = 0.004) compared to the non-chronic group. Univariate analysis confirmed that CME (p = 0.007) and longer symptom duration (p = 0.002) correlated significantly with chronic uveitis. Multivariate analysis identified CME and longer symptom duration prior to treatment as significantly correlated with chronic uveitis (p = 0.043 and p = 0.036, respectively). CME is significantly associated with the development of chronic syphilitic uveitis. Patients with worse presenting visual acuity and longer symptom duration prior to treatment may be at higher risk. These findings underscore the importance of early diagnosis and prompt management in preventing chronic inflammation and preserving visual outcomes.