Temporal Patterns of Posterior Segment Imaging Findings and Laboratory Correlates in Ocular Syphilis.

PURPOSE: To evaluate whether posterior segment imaging findings in ocular syphilis demonstrate reproducible temporal patterns relative to symptom duration. DESIGN: Retrospective case series. METHODS: Patients diagnosed with ocular syphilis between 2015 and 2025 were retrospectively reviewed. Posterior segment imaging was graded across color fundus photography, fluorescein angiography, optical coherence tomography, and near-infrared reflectance. Imaging findings observed in ≥5 eyes were evaluated across symptom-duration intervals and compared between earlier and later presentations using generalized estimating equation (GEE) logistic regression to account for within-patient correlation. Hierarchical clustering and principal component analysis (PCA) were used to characterize temporal imaging patterns. Associations between symptom duration and laboratory parameters, including rapid plasma reagin (RPR) titers and cerebrospinal fluid (CSF) markers, were assessed using Spearman correlation. RESULTS: Forty patients (73 eyes) were included, with posterior segment imaging available in 24 patients (46 eyes). Imaging abnormalities were more frequently detected among patients presenting earlier after symptom onset (≤8 weeks). OCT disc edema was significantly enriched in earlier presentations, while paravenous retinal edema, outer retinal white spots, and near-infrared linear reflectivity change demonstrated similar temporal trends. Several structural abnormalities, including placoid lesions, ellipsoid zone disruption, and subretinal hyperreflective lesions, were observed across all symptom-duration intervals. Hierarchical clustering identified four distinct temporal patterns of imaging findings, with PCA providing complementary visualization of feature relationships. RPR titers showed a moderate inverse correlation with symptom duration (r = -0.45, p = 0.004), while CSF parameters demonstrated similar but nonsignificant negative trends. CONCLUSIONS: Posterior segment imaging findings in ocular syphilis demonstrate nonrandom temporal patterns that may inform clinical interpretation relative to symptom duration.