American journal of ophthalmology
July 21, 2026 · via Europe PMC
The Stalagmite Sign: A Novel Optical Coherence Tomography-Infrared Biomarker for Peripheral Infectious Retinitis.
Lasave AF, Schlaen A, Colombero DN, +7 more, Arevalo JF.
AI summary — for doctors, generated from the abstract only
The Stalagmite Sign on OCT had 99.1% specificity for infectious peripheral retinitis, mostly toxoplasmosis, but low sensitivity.
What was studied
Multicenter retrospective case series of 46 sign-positive eyes plus 360 sign-negative comparators.
Key findings
- Infection was confirmed in 95.7% of sign-positive eyes (toxoplasmosis 69.6%, herpetic 15.2%, syphilis 6.5%, fungal 4.3%).
- Specificity 99.1%, PPV 95.7%, LR+ 24.5, sensitivity 22.9%; PCR positive in all 18 tested.
- Deposits resolved within 3 months of antimicrobial therapy.
Clinical relevance
Recognizing the sign should prompt PCR and antimicrobial therapy and avoid steroid monotherapy.
Who should care
Limitations
Retrospective, with sign-negative comparators making sensitivity uncertain.
Treat presence of the sign as infectious until proven otherwise.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Purpose
To define and evaluate the Stalagmite Sign, a multimodal pattern of multifocal, elongated, elevated, hyperreflective preretinal deposits on spectral-domain optical coherence tomography corresponding to discrete nodular paravascular hyporeflective lesions on coregistered near-infrared reflectance imaging, as a diagnostic biomarker for infectious peripheral retinitis in patients with posterior uveitis.
Design
Multicenter retrospective case series with diagnostic accuracy analysis.
Subjects
Forty-six eyes (44 patients) with the Stalagmite Sign, evaluated at tertiary uveitis referral centers between January 2024 and December 2025. For diagnostic accuracy analysis, 360 sign-negative comparator eyes were added (148 infectious, 212 noninfectious posterior uveitis), total: 406 eyes.
Methods
A 2 × 2 contingency table was constructed using confirmed etiology as the reference standard, and diagnostic accuracy metrics were calculated with Wilson score 95% confidence intervals. Clinical features, intraocular polymerase chain reaction (PCR) results, and visual outcomes were assessed.
Main outcome measures
Sensitivity, specificity, positive predictive value, and positive likelihood ratio (LR+) of the Stalagmite Sign for the diagnosis of infectious peripheral retinitis; intraocular PCR positivity rate; deposit resolution following antimicrobial therapy; and best-corrected visual acuity outcomes.
Results
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%). Two cases were noninfectious, presenting with deposits following silicone-oil removal, with spontaneous resolution. Specificity was 99.1% (95% CI 96.7%-99.7%), positive predictive value 95.7% (95% CI 85.5%-98.8%), and LR+ 24.5; sensitivity was 22.9% (95% CI 17.5%-29.4%). PCR was positive in all 18 eyes. Deposits resolved within 3 months of antimicrobial therapy. Mean logMAR best-corrected visual acuity improved from 0.64 ± 0.40 to 0.43 ± 0.45 over 9.7 months mean follow-up (Friedman test, P < .001).
Conclusions
The Stalagmite Sign is a high-specificity OCT-infrared biomarker (99.1%, LR+ 24.5) for infectious peripheral retinitis, whose recognition should prompt comprehensive peripheral retinal evaluation, intraocular PCR, and antimicrobial therapy, while withholding corticosteroid monotherapy to prevent fulminant retinal necrosis. PCR is especially recommended in diagnostically uncertain cases, as a positive result is highly likely in the presence of the Stalagmite Sign.
DOI
10.1016/j.ajo.2026.07.028
PMID
42480825
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
Want more like this?
Browse more from the feed. A free account unlocks the full feed, saving and communities.
Back to the research feed