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Beyond placoid: diverse clinical presentations and functional outcomes of acute syphilitic posterior placoid chorioretinopathy

Eye (2026)Cite this article

Subjects

Abstract

Objectives

Acute syphilitic posterior placoid chorioretinopathy (ASPPC) is traditionally viewed as a uniform presentation of syphilitic posterior uveitis, though recent evidence suggests broader phenotypic variability. This study aimed to characterise ASPPC heterogeneity using multimodal imaging (MMI).

Methods

Single-centre retrospective cohort study on patients presenting with syphilitic posterior uveitis or panuveitis. MMI included fundus autofluorescence (FAF), fluorescein angiography (FA), indocyanine green angiography (ICGA), and optical coherence tomography (OCT). Cases were classified as typical ASPPC when a unifocal, well-demarcated placoid lesion was present at the posterior pole, and as atypical when multifocal lesions were funduscopically occult but evident on FAF. Macular sensitivity recovery post-antibiotic treatment was evaluated in a subset of cases using microperimetry.

Results

Among 33 eyes from 21 patients (median age: 51 years, 91% male), 55% had typical ASPPC and 45% an atypical presentation. HIV co-infection was found only in patients with a typical placoid lesion (42%). Both phenotypes consistently demonstrated hyperautofluorescent lesions on FAF, which corresponded to late-phase hypofluorescence on ICGA and ellipsoid zone disruption on OCT. Atypical cases showed a higher prevalence of vitritis (53% vs. 44%, P < 0.001), uveitic macular oedema (27% vs. 0%), and peripheral vascular leakage (73% vs. 28%, P = 0.004). Macular sensitivity improved by a mean of 1.7 dB/month (P = 0.005), with no significant difference observed between typical and atypical presentations.

Conclusion

This study broadens the clinical spectrum of ASPPC by characterising atypical funduscopically occult presentations. Despite phenotypic differences, all cases share identical MMI features, although atypical forms may exhibit more pronounced posterior segment inflammation.

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Fig. 1: Typical and atypical presentations of acute syphilitic posterior placoid chorioretinopathy (ASPPC) on pseudocolour retinography, fundus autofluorescence (FAF) and indocyanine green angiography (ICGA).
Fig. 2: Late-phase fluorescein angiography (FA) leakage in acute syphilitic posterior placoid chorioretinopathy (ASPPC).
Fig. 3: Topographic correspondence between late-phase indocyanine green angiography (ICGA) hypofluorescence and fluorescein angiography (FA) leakage in acute syphilitic posterior placoid chorioretinopathy (ASPPC).
Fig. 4: MAIA microperimetry: 68-point macular sensitivity and deviation maps in acute syphilitic posterior placoid chorioretinopathy (ASPPC).

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. School of Medicine, Vita-Salute San Raffaele University, Milan, Italy

    Lorenzo Bianco, Maria Vittoria Cicinelli, Leonardo Bottazzi, Matteo Menean, Aurelio Apuzzo, Giulio Modorati, Francesco Bandello & Elisabetta Miserocchi

  2. Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Lorenzo Bianco, Maria Vittoria Cicinelli, Alessandro Marchese, Leonardo Bottazzi, Adelaide Pina, Matteo Menean, Giulio Modorati, Francesco Bandello & Elisabetta Miserocchi

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Contributions

All the authors contributed to the conception or design of the work (LB, MVC, AM), the acquisition (LBi, MM, AP, AA), analysis (LBi, LBo, MM, AP, AA), and interpretation of data (MVC, LB, EM, FB), drafting of the work (LB, MVC, AM, EM), revising it critically for intellectual content (LB, MVC, AM, EM, FB). Each of the coauthors has seen and agrees with the way his or her name is listed.

Corresponding author

Correspondence to Maria Vittoria Cicinelli.

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Competing interests

The authors have no competing interest in publishing the present work or conflict of interest to disclose. Francesco Bandello discloses consulting fees for Abbvie, Alimera Sciences, Bayer, Boehringer-ingelheim, Fidia-sooft, Hofmann-La-Roche, Novartis, NTC pharma, Oxurion NV, SIFI.

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Bianco, L., Cicinelli, M.V., Marchese, A. et al. Beyond placoid: diverse clinical presentations and functional outcomes of acute syphilitic posterior placoid chorioretinopathy. Eye (2026). https://doi.org/10.1038/s41433-026-04272-z

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