Ocular syphilis unmasked following intravitreal triamcinolone injection.

PURPOSE: To report intravitreal triamcinolone (IVTA)-induced unmasking of ocular syphilis.

DESIGN: Two case reports.

METHODS: A homosexual, diabetic male with macular edema treated with bilateral IVTA and a male with bilateral panuveitis and macular edema who underwent vitrectomy and IVTA. Both developed occlusive retinal vasculitis and panuveitis postinjection. Syphilis serology was positive although both denied previous symptoms.

RESULTS: Intramuscular penicillin lead to resolution of inflammation but both sustained severe loss of vision. Cause-and-effect relationship demonstrated between IVTA and reactivation of syphilis.

CONCLUSIONS: Intravitreal corticosteroid can modulate the immune response to intraocular syphilis; vigilance is required, particularly in high-risk patients.