Transocular sonography in acute arterial occlusions of the eye in elderly patients: Diagnostic value of the spot sign

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 a...

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Bibliographic Details
Published in:PloS one 2021-02, Vol.16 (2), p.e0247072-e0247072
Main Authors: Czihal, Michael, Lottspeich, Christian, Köhler, Anton, Prearo, Ilaria, Hoffmann, Ulrich, Priglinger, Siegfried G, Mackert, Marc J
Format: Article
Language:English
Subjects:
Aged patients
Analysis
Arterial occlusions
Arteries
Biology and Life Sciences
Biopsy
C-reactive protein
Cardiovascular diseases
Diagnosis
Diagnostic systems
Editing
Embolisms
Etiology
Eye diseases
Eye lens
Ischemia
Jaw
Medical diagnosis
Medicine
Medicine and Health Sciences
Methodology
Methods
Neuropathy
Occlusion
Older people
Ophthalmology
Optic nerve
Optic neuropathy
Patients
Physiological aspects
Polymyalgia rheumatica
Reperfusion
Research and Analysis Methods
Retina
Social Sciences
Thickening
Thrombolysis
Ultrasonic imaging
Ultrasound
Ultrasound imaging
Veins & arteries
Visual impairment
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Summary: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.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0247072