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The Stalagmite Sign: A Novel Optical Coherence Tomography-Infrared Biomarker for Peripheral Infectious Retinitis
Andres F Lasave1, Ariel Schlaen2, Daniel N Colombero3
1From the Retina and Vitreous Department (A.F.L.), Clínica Privada de Ojos (CPO), Mar del Plata, Buenos Aires, Argentina.
American Journal of Ophthalmology
|July 21, 2026
Summary
The Stalagmite Sign on OCT-IR imaging is a highly specific biomarker for infectious peripheral retinitis. Its identification aids in diagnosing and managing this condition, guiding treatment decisions.
Area of Science:
- Ophthalmology
- Medical Imaging
- Infectious Diseases
Background:
- Posterior uveitis can present with diverse retinal manifestations.
- Accurate diagnosis of infectious peripheral retinitis is crucial for appropriate management.
- Novel imaging biomarkers are needed to improve diagnostic accuracy.
Purpose of the Study:
- To define the Stalagmite Sign, a multimodal OCT-IR imaging pattern.
- To evaluate the Stalagmite Sign as a diagnostic biomarker for infectious peripheral retinitis in posterior uveitis.
- To assess the diagnostic accuracy of the Stalagmite Sign.
Main Methods:
- Multicenter retrospective case series with diagnostic accuracy analysis.
- Inclusion of 46 eyes with the Stalagmite Sign and 360 sign-negative comparator eyes.
- Calculation of sensitivity, specificity, positive predictive value, and likelihood ratio; assessment of PCR positivity and visual outcomes.
Main Results:
- The Stalagmite Sign was present in 46 eyes, with 95.7% confirmed infectious etiology (toxoplasmosis, herpetic retinitis, syphilis, fungal endophthalmitis).
- High specificity (99.1%) and positive predictive value (95.7%) for infectious peripheral retinitis were observed.
- Intraocular PCR was positive in all tested eyes, and visual acuity improved with antimicrobial therapy.
Conclusions:
- The Stalagmite Sign is a highly specific OCT-IR biomarker for infectious peripheral retinitis.
- Recognition of the Stalagmite Sign should prompt peripheral retinal evaluation, PCR, and antimicrobial therapy.
- Avoid corticosteroid monotherapy; PCR is recommended in uncertain cases.
