The Stalagmite Sign: A Novel OCT-IR Biomarker for Peripheral Infectious Retinitis.
The Stalagmite Sign on OCT-IR imaging is highly specific for infectious peripheral retinitis.
The Stalagmite Sign: A Novel OCT-IR Biomarker for Peripheral Infectious Retinitis.
To define and evaluate the Stalagmite Sign, a multimodal pattern of multifocal, elongated, elevated, hyperreflective preretinal deposits on spectral-domain optical coherence tomography (spectral-domain optical coherence tomography) corresponding to discrete nodular paravascular hyporeflective lesions on co-registered near-infrared (IR) reflectance imaging, as a diagnostic biomarker for infectious peripheral retinitis in patients with posterior uveitis.
Multicenter retrospective case series with diagnostic accuracy analysis.
study eyes without infection were almost never wrongly flagged as positive
An infectious etiology was confirmed in 44 (95.7%) of 46 sign-positive eyes: toxoplasmosis (32, 69.6%), herpetic retinitis (7, 15.2%), ocular syphilis (3, 6.5%), and fungal endophthalmitis (2, 4.3%).
Peripheral retinitis was identified in 35 (76.1%) eyes; posterior pole retinitis in only 8 (17.4%).
Polymerase chain reaction was positive in all 18 eyes.
Deposits resolved within 3 months of antimicrobial therapy.
The Stalagmite Sign is a high-specificity OCT-IR biomarker (99.1%, LR+ 24.5) for infectious peripheral retinitis, whose recognition should prompt comprehensive peripheral retinal evaluation, intraocular polymerase chain reaction, and antimicrobial therapy, while withholding corticosteroid monotherapy to prevent fulminant retinal necrosis.
polymerase chain reaction is especially recommended in diagnostically uncertain cases, as a positive result is highly likely in the presence of the Stalagmite Sign.