Division of Vascular Medicine, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, Munich, Germany.
Department of Ophthalmology, Klinikum der Universität München, LMU München, Munich, Germany.
PLoS One. 2021 Feb 12;16(2):e0247072. doi: 10.1371/journal.pone.0247072. eCollection 2021.
To characterize the diagnostic yield of the spot sign in the diagnostic workup of acute arterial occlusions of the eye in elderly patients.
Clinical characteristics of consecutive patients aged ≥ 50 years with acute central retinal artery occlusion (CRAO), branch retinal artery occlusion (BRAO) or anterior ischemic optic neuropathy (AION) were recorded. Videos of transocular sonography were assessed for the presence of the spot sign by two blinded readers. Group comparisons were made between CRAO-patients with and without the spot sign. Two experienced cardiovascular physicians allocated CRAO-cases to a presumed aetiology, without and with knowledge on the presence/absence of the spot sign.
One-hundred-twenty-three patients were included, 46 of whom suffered from CRAO. A spot sign was seen in 32 of 46 of patients with CRAO and in 7 of 23 patients with BRAO. Interobserver agreement was excellent (Cohen`s kappa 0.98). CRAO-patients with the spot sign significantly more frequently had a medical history of cardiovascular disease (62.8 vs. 21.4%, p = 0.03) and left heart valve pathologies (51.9 vs. 10%, p = 0.03). The spot sign was not found in any of the three patients with CRAO secondary to cranial giant cell arteritis. The assumed CRAO aetiology differed in 37% of cases between two cardiovascular physicians, regardless whether transocular sonography findings were known or not.
The spot sign is a simple sonographic finding with excellent interobserver agreement, which proofs the embolic nature of CRAO, but does not allow exact attribution of the underlying aetiology.
描述老年患者急性眼部动脉闭塞性病变中斑点征的诊断价值。
记录了连续就诊的≥50 岁的急性中央视网膜动脉阻塞（CRAO）、分支视网膜动脉阻塞（BRAO）或前部缺血性视神经病变（AION）患者的临床特征。两名盲法读者评估经眼超声视频中斑点征的存在情况。比较 CRAO 患者中斑点征阳性和阴性患者的组间差异。两名经验丰富的心血管医师在不知道和知道斑点征的情况下，将 CRAO 病例分配为假定病因。
共纳入 123 例患者，其中 46 例患有 CRAO。32/46 例 CRAO 患者和 7/23 例 BRAO 患者存在斑点征。观察者间一致性极好（Cohen`s kappa 0.98）。斑点征阳性的 CRAO 患者更常患有心血管疾病病史（62.8% vs. 21.4%，p = 0.03）和左心瓣膜病变（51.9% vs. 10%，p = 0.03）。斑点征在 3 例因颅 giant cell arteritis 引起的 CRAO 患者中均未发现。两名心血管医师在不知道或知道经眼超声检查结果的情况下，有 37%的病例假设的 CRAO 病因不同。
斑点征是一种简单的超声表现，具有极好的观察者间一致性，证实了 CRAO 的栓塞性质，但不能准确归因于潜在病因。
