Peripapillary hyperreflective ovoid mass-like structures—a novel entity as frequent cause of pseudopapilloedema in children

Mezad-Koursh, Daphna; Klein, Ami; Rosenblatt, Amir; Roth, Sharon; Neudorfer, Meira; Loewenstein, Anat; Iglicki, Matías; Zur, Dinah

doi:10.1038/s41433-020-1067-x

Cited by 23 publications

(38 citation statements)

References 24 publications

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“…Yan et al reported a hypo‐AF signal in a ring or crescent around the disc margin, corresponding to the extent of PHOMS, attributed to an absence of the underlying retinal pigment epithelium (Figure 1E). 27 In contrast Mezad‐Koursh et al found small hyper‐AF spots in 47% of the eyes with PHOMS with good inter‐observer reliability 26 . These lesions did not correlate with age or US features.…”

Section: Multimodal Imaging Features Of Phomsmentioning

confidence: 92%

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

Jeffery

Chen

2022

Clinical Exper Ophthalmology

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Peripapillary hyperreflective ovoid mass-like structures (PHOMS) are a laterally bulging herniation of distended axons into the peripapillary region above the level of Bruch's membrane opening. Increased use of enhanced depth imaging-optical coherence tomography (EDI-OCT) in our evaluation of the optic nerve head (ONH) and greater recognition of the vast range of optic nerve pathologies with which PHOMS is associated provides convincing evidence that PHOMS is not just buried optic disc drusen (ODD) as previously described. The frequent coexistence of PHOMS with ODD, papilloedema, anterior ischaemic optic neuropathy, tilted optic disc syndrome, inflammatory demyelinating disorders and other diseases associated with axoplasmic stasis provides insight into its underlying pathophysiology. The present review will discuss the role of key imaging modalities in the differential diagnosis of PHOMS, explore the current literature on the relationship between PHOMS and common neuro-ophthalmic conditions, and highlight the gaps in our knowledge, with respect to disease classification and prognosis, to pave the way for future directions of research.

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Section: Multimodal Imaging Features Of Phomsmentioning

confidence: 92%

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

Jeffery

Chen

2022

Clinical Exper Ophthalmology

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“…In previous studies, PHOMS was found in cases of optic disc drusen (ODD), optic disc edema (ODE), pseudo-optic disc edema, tilted disc syndrome (TDS), and optic neuritis, as well as other diseases (8,(12)(13)(14)(15). We found that PHOMS was also present in ischemic optic neuropathy and white dot syndromes.…”

Section: Discussionmentioning

confidence: 71%

“…In addition, OCT features of normal vessels are similar to those of vessels with PHOMS. However, the retina's vascular structures are located on the surface of the optic disc, and PHOMS structures are located subretinally and above Bruch's membrane ( 14 ). PHOMS were also observed in patients with myopic tilted discs, which is not related to papilledema nor ODD.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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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.

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“…12 eyes with buried ONHD had no evidence of pseudopapilledema on funduscopy nor did OCT demonstrate PHOMS [18]. Mezad-Koursh et al [26 ▪ ] reported on pediatric patients with pseudopapilledema and found that PHOMS were found in 93.8% of eyes with pseudopapilledema; whereas, ONHD were found in only 20.3%. The authors stated this study established PHOMS as a cause of pseudopapilledema; however, it seems more likely that PHOMS are an associated marker rather than a cause since they can be seen in many other conditions [5].…”

Section: The Relationship Between Peripapillary Hyperreflective Ovoid...mentioning

confidence: 99%

An overview of peripapillary hyperreflective ovoid mass-like structures

Chapman

Heidary

Gise

2022

Current Opinion in Ophthalmology

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Purpose of reviewThe purpose of this review is to provide an overview of the ophthalmic findings associated with peripapillary hyperreflective ovoid mass-like structures (PHOMS) in both adult and pediatric patients.Recent findingsPHOMS have recently been identified in a number of different ophthalmic disease entities ranging from nonpathologic to pathologic, including but not limited to anatomic abnormalities (tilting in myopia), optic nerve head drusen, optic disc edema from inflammation (optic neuritis, white dot syndromes), vascular insults (ischemic optic neuropathy, retinal vascular occlusion), and papilledema. The mechanism underlying the formation of PHOMS has not been fully elucidated although it has been hypothesized that PHOMS occur secondary to axoplasmic stasis from crowding at the optic nerve head.SummaryAlthough the clinical significance of the presence of PHOMS remains unclear, PHOMS are associated with several disease processes. Understanding the mechanism behind their formation and their impact on optic nerve head structure and visual function may be relevant in patients with optic nerve head pathology. The presence of PHOMS may also correlate with disease severity and duration. Future studies to evaluate whether the formation of PHOMS may be useful as an early indicator of disease or a prognostic tool are warranted.

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Peripapillary hyperreflective ovoid mass-like structures—a novel entity as frequent cause of pseudopapilloedema in children

Cited by 23 publications

References 24 publications

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

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

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

An overview of peripapillary hyperreflective ovoid mass-like structures

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