Wide field swept source OCT angiography in acute syphilitic placoid chorioretinitis

PURPOSE: To describe the clinical and swept source OCT angiographic features of a patient with acute syphilitic posterior placoid chorioretinitis (ASPPC). OBSERVATIONS: A 67-year-old man presented with acute loss of vision in the left eye. On exam, we noted a yellowish placoid lesion in the macula. Optical coherence tomography (OCT) imaging showed RPE nodularity and disruption of the inner segment-outer segment region in the left eye. Fluorescein angiography showed early hyperfluorescent and late staining within the placoid lesions. Wide field swept source OCT angiography (SS-OCTA) showed macular choriocapillaris perfusion flow deficits. Laboratory tests revealed positive 1:128 rapid plasma reagin titer and fluorescent treponemal antibody absorption (FTA-ABS) tests. OCT imaging revealed complete restoration of the IS-OS boundary layer with near complete resolution of the RPE granularity after adequate penicillin therapy. SS-OCTA showed resolution of choriocapillaris flow deficit in the left eye. Improvement in BCVA correlated with improvement in choriocapillaris perfusion. CONCLUSIONS AND IMPORTANCE: This is the first case that describes long-term SS-OCTA findings in ASPPC. SS-OCTA is a fast, safe, and easily repeatable imaging modality that offers valuable insights in our understanding of the pathophysiology and the response to treatment of ASPPC.