Clinical and Multi-Mode Imaging Features of Eyes With Peripapillary Hyperreflective Ovoid Mass-Like Structures

Abstract

PurposeTo observe and analyze the clinical and multi-mode imaging features of eyes with PHOMS, and to introduce two cases of PHOMS which underwent multi-mode imaging.MethodsRetrospective clinical observational study. A total of 26 patients (37 eyes) with hyperreflective structures surrounded by hyporeflective edges around the optic discs who were examined and diagnosed at Shandong Eye Hospital between January 2019 and June 2021 were included in the study. Among these patients, 12 were male and 14 were female. Fifteen were monocular. The average age was 39 years. All patients underwent the following examinations: Best-corrected visual acuity (BCVA), intraocular pressure examinations, slit-lamp anterior segment examinations, indirect ophthalmoscopy, visual field examinations, fundus color photography, fundus autofluorescence (FAF), optical coherence tomography (OCT), and optical coherence tomography angiography (OCTA). Some of the patients were examined with fundus fluorescein angiography (FFA). Clinical data and imaging characteristics from the OCT, OCTA, and FFA were analyzed retrospectively.ResultsWe found the hyperreflective structures surrounded by hyporeflective edges around the optic discs in 37 eyes. EDI-OCT results revealed hyperreflective structures surrounded by hyporeflective edges around the optic discs in all eyes. Typical hyperreflexia lesions occurred around the optic disc, located subretinally and above Bruch's membrane. OCTA revealed that the highly reflective perioptic material also had vascular structures.ConclusionEDI-OCT of PHOMS showed hyperreflective structures surrounded by hyporeflective edges around all of the optic discs. Infra-red photography showed temporal hyperreflexia. These characteristics can be seen in a variety of diseases and may be a relatively common feature revealed by EDI-OCT scanning. These characteristics may also be seen in elderly patients as well as children. PHOMS may be found in optic disc drusen (ODD), tilted disc syndrome (TDS), optic neuritis, ischemic optic neuropathy, and in white dot syndromes. Few patients may be developed into macular neovascularization (MNV). In order to improve the accuracy and robustness of the conclusions and provide better clinical guidance, we need to conduct more comprehensive research in the subsequent clinical work.

Peripapillary hyperreflective ovoid mass‐like structures: Multimodal imaging—A review

“…The location of the OCT slice determines the morphology of the ovoid structure. In a cross‐sectional study of PHOMS, the mean height and width of this ovoid lesion was 399 and 721 μm respectively 21 Effect on surrounding tissues: The plane of Bruch's membrane is unaffected in contrast to the inner retinal layers (2 or more) which are displaced upwards to give the impression of a blurred and elevated disc margin.…”

“…Internal vascular flow signals have been observed by two independent groups using OCT‐angiography (OCTA) suggesting an intrinsic vascular supply (Figure 1B). 20,21 However, Kim et al reported a lack of flow signal as a supporting argument for PHOMS being composed of extracellular drusen material 22 . Mezad‐Koursh et al also found 94% of PHOMS showing internal hyperreflective foci which they proposed were early calcium deposits despite the lack of supporting histological evidence. Shape: on cross‐sectional view, PHOMS appears ovoid without any associated complex geometric shapes.…”

“…However, it is not clear how often this feature is also seen in other causes of disc swelling without PHOMS. In contrast to ODD, PHOMS typically do not show a hyper‐AF signal on short wavelength FAF imaging 21 . Studies that described ‘peripapillary ODD’ also noted that these PHOMS‐like lesions lack the hyper‐AF typically seen in traditional ODD 17 .…”

An overview of peripapillary hyperreflective ovoid mass-like structures

“…PHOMS have been reported for in various retinal pathologies such as choroidal neovascularization, dome-shaped maculopathy, retinal vascular occlusions, and white dot syndromes [25,31,33]. As macular edema has been demonstrated to be associated with PHOMS resulting from axonal stasis, this may be the mechanism through which PHOMS developed in patients with choroidal neovascularization and dome-shaped maculopathy [40].…”

“…PHOMS have been identified in association with other conditions affecting the optic nerve, including multiple sclerosis (MS), idiopathic intracranial hypertension (IIH), diabetic papillopathy, nonarteritic anterior ischemic optic neuropathy (NA-AION), retinal vascular occlusions, macular neovascularization, dome-shaped maculopathy, white dot syndromes, and optic atrophy [12,25,31,32,33,34 ▪▪ ,35,36] (Table 1).…”