The purpose of this study is to report retinal manifestations of lues
in human immunodeficiency virus (HIV)-positive patients and to suggest
a method for treatment of rhegmatogenous retinal detachments in these
patients. Two HIV-positive patients with bilateral retinitis were exa
mined and treated at the authors' institution for a period of 14 month
s. Ocular syphilis was diagnosed clinically, confirmed by cerebrospina
l fluid serologic testing, and treated with intravenous penicillin. Bo
th patients experienced bilateral rhegmatogenous retinal detachments c
omplicated by proliferative vitreoretinopathy after resolution of the
active retinitis. All four eyes underwent surgical repair with trans p
ars plana vitrectomy, epiretinal membrane delamination, gas-fluid exch
ange, endolaser, scleral buckle, and silicone oil instillation. The re
cognition of ocular syphilis as a cause of retinal detachment in HIV-p
ositive patients is important. Prompt intervention with the appropriat
e medical and surgical treatments may result in the preservation of vi
sion in these patients.