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Takayama T, Makino S, Tampo H. Peripapillary Hyperreflective Ovoid Mass-Like Structures as a Finding in Pseudopapilledema in Children. Klin Monbl Augenheilkd 2024. [PMID: 38670120 DOI: 10.1055/a-2294-4853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Affiliation(s)
| | - Shinji Makino
- Ophthalmology, Jichi Medical University, Shimotsuke, Japan
| | - Hironobu Tampo
- Ophthalmology, Jichi Medical University, Shimotsuke, Japan
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2
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Xiao D, Lhamo T, Meng Y, Xu Y, Chen C. Peripapillary hyperreflective ovoid mass-like structures: multimodal imaging and associated diseases. Front Neurol 2024; 15:1379801. [PMID: 38606274 PMCID: PMC11006981 DOI: 10.3389/fneur.2024.1379801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/18/2024] [Indexed: 04/13/2024] Open
Abstract
Growing evidence has demonstrated that peripapillary hyperreflective ovoid mass-like structures (PHOMS) are novel structures rather than a subtype of optic disc drusen. They correspond to the laterally bulging herniation of optic nerve fibers and are believed to be the marker of axoplasmic stasis. PHOMS present in a broad spectrum of diseases, including optic disc drusen, tilted disc syndrome, papilloedema, multiple sclerosis, non-arteritic anterior ischemic optic neuropathy, optic neuritis, Leber hereditary optic neuropathy, and so on. We focus on the multimodal imaging features, pathophysiological mechanisms of PHOMS, and their association with multiple diseases and healthy people in this review to deepen the ophthalmologists' understanding of PHOMS. Additionally, we provide some new directions for future research.
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Affiliation(s)
| | | | | | - Yishuang Xu
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Changzheng Chen
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
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Rabinovich M, Seray S, Amoroso F, Madar C, Souied EH. Peripapillary hyperreflective ovoid mass-like structures and the retinal nerve fiber layer thinning. Eur J Ophthalmol 2024; 34:NP126-NP130. [PMID: 37904532 DOI: 10.1177/11206721231211419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
AIM We describe a report of three cases of bilateral Peripapillary Hyperreflective Ovoid Mass-Like Structures (PHOMS), their respective multimodal imaging, and retinal nerve fiber layer (RNFL) analysis over time. METHODS We performed an elaborated multimodal imaging of three pediatric patients with PHOMS. We performed a visual acuity testing, followed by a biomicroscopic and fundus examination, an additional Optical Coherence Tomography (OCT), fundus autofluorescence (FAF), infra-red (IR), fluorescein angiography (FA), Scanning laser Ophtalmoscopy (SLO), and retro-mode imaging. Furthermore, we analyzed RNFL thickness over several consecutive visits. RESULTS The multimodal approach exhibited similar characteristics of PHOMS in all eyes, namely a torus-like shaped that was particularly demarcated and well visualized using SLO and retro-mode tool. In all the eyes, we found a downward trend of the RNFL over time. In both the right and left eye, RNFL at presentation averaged at 152.33 ± 25.42 and 130 ± 18.33 microns, respectively. Several weeks after, it averaged at 142 ± 30.34 and 125.67 ± 14.84 microns, respectively. CONCLUSIONS Our report shows a thinning trend of the RNFL thickness over time in patients with PHOMS.
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Affiliation(s)
- Mark Rabinovich
- Department of Ophthalmology, University of Paris Est-Créteil, Créteil, France
| | - Samia Seray
- Department of Ophthalmology, University of Paris Est-Créteil, Créteil, France
| | - Francesca Amoroso
- Department of Ophthalmology, University of Paris Est-Créteil, Créteil, France
| | - Charles Madar
- Department of Ophthalmology, University of Paris Est-Créteil, Créteil, France
| | - Eric H Souied
- Department of Ophthalmology, University of Paris Est-Créteil, Créteil, France
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Wang W, Liu J, Xiao D, Yi Z, Chen C. Features of Peripapillary Hyperreflective Ovoid Mass-Like Structures in Nonarteritic Anterior Ischemic Optic Neuropathy Patients and Normal Controls. Transl Vis Sci Technol 2024; 13:7. [PMID: 38214687 PMCID: PMC10790673 DOI: 10.1167/tvst.13.1.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 12/01/2023] [Indexed: 01/13/2024] Open
Abstract
Purpose To determine the characteristics of peripapillary hyperreflective ovoid mass-like structures (PHOMS) in patients with nonarteritic anterior ischemic optic neuropathy (NAION) and in normal adults. Methods A total of 406 included eyes were divided into four groups: acute NAION group, chronic NAION group, unaffected group, and normal eyes group. PHOMS were detected on optical coherence tomography slices from optical coherence tomography angiography scans centered on the optic nerve head (ONH). The differences in age, sex, and ONH parameters were investigated between eyes with PHOMS and eyes without PHOMS among groups. Results The prevalence of PHOMS in acute eyes (43.48%) and fellow eyes (28.20%) was significantly higher than that in normal eyes (11.76%) (acute vs. normal, P < 0.001; fellow vs. normal, P = 0.014). In the acute group, the PHOMS score of size was negatively correlated with age in acute eyes (r = -0.486, P = 0.03). The size of PHOMS was negatively correlated with age and cup/disc ratio and positively correlated with retinal nerve fiber layer thickness in the nasal and inferior sectors in the normal groups. No differences in age, sex, ONH parameters, or visual field defects were found between eyes with PHOMS and eyes without PHOMS. Conclusions The prevalence of PHOMS increased significantly in acute nonoptic disc drusen (NODD)-NAION eyes and fellow eyes. PHOMS could also be found among normal adults. PHOMS may be a nonspecific sign secondary to ONH edema and axoplasmic stasis. Translational Relevance The high prevalence of PHOMS in acute NODD-NAION eyes may indicate axoplasmic stasis secondary to tissue edema.
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Affiliation(s)
- Wenyu Wang
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Juejun Liu
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Di Xiao
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zuohuizi Yi
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Changzheng Chen
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
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Bassi ST, Pamu R, Varghese A. Understanding pseudopapilledema on spectral domain optical coherence tomography. Indian J Ophthalmol 2023; 71:3552-3557. [PMID: 37870023 PMCID: PMC10752308 DOI: 10.4103/ijo.ijo_3146_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 05/29/2023] [Accepted: 06/17/2023] [Indexed: 10/24/2023] Open
Abstract
Purpose Optic nerve head drusen (ONHD), peripapillary hyperreflective ovoid mass-like structures (PHOMS), and horizontal hyperreflective lines (HHL) are commonly seen in eyes with pseudopapilledema on enhanced depth imaging (EDI) spectral domain optical coherence tomography (SDOCT). The objective of this study is to assess the frequency of ONHD, PHOMS, and HHL on spectral domain OCT in the eyes diagnosed to have pseudopapilledema. Methods A retrospective case-control study included patients diagnosed as pseudopapilledema and had EDI SD OCT imaging of the optic nerve head (n = 48 eyes) and controls (n = 20 eyes). OCT scans through the optic nerve head were studied to diagnose ONHD, HHL, and PHOMS. One proportion z test was used to find the difference in proportions. Results Forty eight eyes of 27 subjects were studied. ONHD as described by the optic disc drusen Studies consortium was noted in 19 eyes (39.48%), P value-0.032, PHOMS in 31 eyes (64.6%), P value 0.043, HL in 19 eyes (39.48%), P value 0.032, and none of the normals had ONHD, PHOMS, and HHL. Conclusions PHOMS are more frequently seen than ONHD and HHL in eyes with pseudopapilledema.
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Affiliation(s)
- Shikha Talwar Bassi
- Neuroophthalmology Services, Sankara Nethralaya, 18 College Road, Chennai, Tamil Nadu, India
| | - Ramesh Pamu
- Comprehensive Ophthalmology, Neuroophthalmology Services, Sankara Nethralaya, 18 College Road, Chennai, Tamil Nadu, India
| | - Anjaly Varghese
- Department of Optometry, Sankara Nethralaya, 18 College Road, Chennai, Tamil Nadu, India
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Kaplan AT, Öskan Yalçın S, Sağer SG. Clinical Findings and Optical Coherence Tomography Measurements of Pediatric Patients with Papilledema and Pseudopapilledema. Turk J Ophthalmol 2023; 53:294-300. [PMID: 37868142 PMCID: PMC10599342 DOI: 10.4274/tjo.galenos.2023.81504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 02/15/2023] [Indexed: 10/24/2023] Open
Abstract
Objectives To compare the clinical findings and multimodal imaging of pediatric patients diagnosed with papilledema and pseudopapilledema with those of healthy individuals. Materials and Methods Ninety children (<18 years of age) referred for suspected papilledema were included in this study. All patients underwent optical coherence tomography (OCT) imaging and were compared with normal control subjects. Results Fifty-eight children diagnosed with pseudopapilledema, 32 children with mild-to-moderate papilledema, and 40 controls were evaluated. The average and all quadrants of retinal nerve fiber layer (RNFL) thickness were significantly higher in the papilledema group than in the pseudopapilledema and control groups (p<0.001). Bruch's membrane opening (BMO) measurements were similar in both groups (p>0.05). The average, nasal, and temporal RNFL thicknesses were significantly higher in the pseudopapilledema group compared with the controls (p<0.001). Area under the receiver operating characteristic (ROC) curve showed high diagnostic ability for RNFL thickness in all quadrants to differentiate papilledema from pseudopapilledema (p<0.001). In the pseudopapilledema group, average, temporal, and inferior RNFL thickness and BMO measurements were significantly higher in eyes with optic nerve head drusen (n=28) compared with those without drusen (n=88) (p=0.035, p=0.022, p=0.040 and, p=0.047 respectively). Conclusion Papilledema and pseudopapilledema show great differences in evaluation, follow-up, and prognosis. Using non-invasive methods such as newly developed OCT techniques in differential diagnosis can relieve patients with pseudopapilledema from the stress and financial burden of expensive, extensive, and invasive procedures.
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Affiliation(s)
- Ayşin Tuba Kaplan
- University of Health Sciences Türkiye, Kartal Dr. Lütfi Kırdar City Hospital, Clinic of Ophthalmology, İstanbul, Türkiye
| | - Sibel Öskan Yalçın
- University of Health Sciences Türkiye, Kartal Dr. Lütfi Kırdar City Hospital, Clinic of Ophthalmology, İstanbul, Türkiye
| | - Safiye Güneş Sağer
- University of Health Sciences Türkiye, Kartal Dr. Lütfi Kırdar City Hospital, Clinic of Pediatric Neurology, İstanbul, Türkiye
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Pratt L, Rehan S, West J, Watts P. Prevalence of peripapillary hyperreflective ovoid mass-like structures (PHOMS) in suspected papilloedema in children. Eye (Lond) 2023; 37:3209-3212. [PMID: 36906695 PMCID: PMC10564775 DOI: 10.1038/s41433-023-02489-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 02/22/2023] [Accepted: 03/03/2023] [Indexed: 03/13/2023] Open
Abstract
PURPOSE Suspected papilloedema is a frequent cause of referral to paediatric ophthalmology clinics. Recent publications have described a new finding called peripapillary hyperreflective ovoid mass-like structures (PHOMS) that may cause pseudopapilloedema. We evaluated the optical coherence tomography (OCT) scans of the optic nerve in all children referred with suspected papilloedema for the presence of PHOMS and report their frequency. METHODS The optic nerve OCT scans from children seen in our suspected papilloedema virtual clinic between August 2016 and March 2021 were evaluated for the presence of PHOMS by three assessors. A Fleiss' kappa statistic was calculated to test the agreement between the assessors for the presence of PHOMS. RESULTS A total of 220 scans from 110 patients were evaluated during the study period. The mean patient age was 11.2 SD ± 3.4, (range 4.1-16.8). PHOMS were identified in at least one eye in 74 (67.3%) patients. Of these, 42 (56.8%) patients had bilateral and 32 (43.2%) had unilateral PHOMS. Excellent agreement between assessors for the presence of PHOMS (Fleiss' kappa 0.9865) was observed. PHOMS were common in association with other identified causes of pseudopapilloedema (81.25%) but were also common in papilloedema (66.67%) and otherwise normal discs (55.36%). CONCLUSIONS Misdiagnosis of papilloedema can lead to unnecessary and invasive tests. PHOMS are found frequently within the paediatric population referred for suspected disc swelling. They appear to be an independent cause of pseudopapilloedema but are often seen in conjunction with true papilloedema and other causes of pseudopapilloedema.
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Affiliation(s)
- Luke Pratt
- Department of Ophthalmology, University Hospital of Wales, Cardiff, CF14 4XW, Wales, UK.
| | - Shahzaib Rehan
- Department of Ophthalmology, University Hospital of Wales, Cardiff, CF14 4XW, Wales, UK
| | - Jack West
- Department of Ophthalmology, University Hospital of Wales, Cardiff, CF14 4XW, Wales, UK
| | - Patrick Watts
- Department of Ophthalmology, University Hospital of Wales, Cardiff, CF14 4XW, Wales, UK
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Li B, Li H, Huang Q, Zheng Y. Peripapillary hyper-reflective ovoid mass-like structures (PHOMS): clinical significance, associations, and prognostic implications in ophthalmic conditions. Front Neurol 2023; 14:1190279. [PMID: 37273687 PMCID: PMC10232827 DOI: 10.3389/fneur.2023.1190279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/02/2023] [Indexed: 06/06/2023] Open
Abstract
Pioneering advancements in optical coherence tomography (OCT) have facilitated the discernment of peripapillary hyper-reflective ovoid mass-like structures (PHOMS), prevalent neuro-ophthalmological findings associated with an array of ophthalmic conditions, such as optic disc drusen (ODD), papilledema, myopic/tilted optic discs, non-arteritic anterior ischemic optic neuropathy (NA-AION), and optic neuritis. Despite an expanding corpus of research, numerous inquiries persist concerning their clinical significance, correlations with ocular afflictions, and prognostic implications. This comprehensive review endeavors to impart an in-depth comprehension of PHOMS, encompassing facets like conceptualization, detection, pathogenesis, and associations with diverse ophthalmic conditions. Furthermore, we underscore several unresolved quandaries and suggest prospective avenues for future exploration.
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Heath Jeffery RC, Chen FK. Peripapillary hyperreflective ovoid mass-like structures: Multimodal imaging-A review. Clin Exp Ophthalmol 2023; 51:67-80. [PMID: 36300762 PMCID: PMC10099767 DOI: 10.1111/ceo.14182] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/04/2022] [Accepted: 10/21/2022] [Indexed: 11/07/2022]
Abstract
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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Affiliation(s)
- Rachael C Heath Jeffery
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Nedlands, Western Australia, Australia.,Royal Victorian Eye and Ear Hospital (Centre for Eye Research Australia), East Melbourne, Victoria, Australia
| | - Fred K Chen
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Nedlands, Western Australia, Australia.,Royal Victorian Eye and Ear Hospital (Centre for Eye Research Australia), East Melbourne, Victoria, Australia.,Ophthalmology, Department of Surgery, The University of Melbourne, East Melbourne, Victoria, Australia.,Department of Ophthalmology, Royal Perth Hospital, Western Australia, Australia
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10
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Behrens CM, Malmqvist L, Jørgensen M, Sibony PA, Munch IC, Skovgaard AM, Larsen M, Hamann S. Peripapillary Hyperreflective Ovoid Mass-like Structures (PHOMS) in Children: The Copenhagen Child Cohort 2000 Eye Study. Am J Ophthalmol 2023; 245:212-221. [PMID: 36108799 DOI: 10.1016/j.ajo.2022.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/05/2022] [Accepted: 09/01/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE To determine the prevalence of peripapillary hyperreflective ovoid mass-like structures (PHOMS) in a population-based child cohort and to study their association with other optic nerve head features and myopia. DESIGN Observational, population-based cohort study of 1407 children aged 11-12 years. METHODS Optical coherence tomography scans of optic nerve heads were graded for PHOMS, disc tilt, prelaminar hyperreflective lines, and scleral canal diameter and investigated for associated prenatal and ocular parameters. Children with optic disc drusen or optic disc edema were excluded. RESULTS PHOMS were found in 8.9% of children. The location of PHOMS was predominantly in the superonasal section of the optic disc. Myopia and optic nerve head tilt were more common in children with PHOMS than in children without PHOMS (P < .001 and P < .001, respectively). Prelaminar hyperreflective lines were found in 17.9% of children with PHOMS compared to 7.3% of children without PHOMS (P < .001). Prelaminar hyperreflective lines with and without PHOMS were associated with a shorter axial length of the eye (P < .001). There were no prenatal factors associated with PHOMS. Prelaminar hyperreflective lines were associated with higher birth weight and continued maternal smoking during pregnancy (P = .01 and P = .02, respectively). CONCLUSIONS PHOMS had a prevalence of 8.9% in healthy children without optic disc drusen or optic disc edema and was associated with increasing myopic refraction and the presence of a tilted optic nerve head and prelaminar hyperreflective lines. Given the high prevalence of PHOMS, they should not unreservedly be taken as evidence of optic neuropathy.
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Affiliation(s)
| | - Lasse Malmqvist
- Department of Ophthalmology, Rigshospitalet(C.M.B., L.M., M.J., M.L., S.H.), Glostrup, Denmark
| | - Morten Jørgensen
- Department of Ophthalmology, Rigshospitalet(C.M.B., L.M., M.J., M.L., S.H.), Glostrup, Denmark
| | - Patrick A Sibony
- Department of Ophthalmology, State University of New York at Stony Brook(P.A.S.), Stony Brook, New York, USA
| | - Inger Christine Munch
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital(I.C.M.), Copenhagen, Denmark
| | - Anne Mette Skovgaard
- National Institute of Public Health, Faculty of Health Sciences, University of Southern Denmark(A.M.S.), Copenhagen, Denmark
| | - Michael Larsen
- Department of Ophthalmology, Rigshospitalet(C.M.B., L.M., M.J., M.L., S.H.), Glostrup, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen(M.L., S.H.), Copenhagen, Denmark
| | - Steffen Hamann
- Department of Ophthalmology, Rigshospitalet(C.M.B., L.M., M.J., M.L., S.H.), Glostrup, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen(M.L., S.H.), Copenhagen, Denmark.
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11
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Chapman JJ, Heidary G, Gise R. An overview of peripapillary hyperreflective ovoid mass-like structures. Curr Opin Ophthalmol 2022; 33:494-500. [PMID: 36094020 DOI: 10.1097/icu.0000000000000897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The 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 FINDINGS PHOMS 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. SUMMARY Although 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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Affiliation(s)
| | - Gena Heidary
- Department of Ophthalmology, Boston Children's Hospital
- Harvard Medical School, Boston, Massachusetts, USA
| | - Ryan Gise
- Department of Ophthalmology, Boston Children's Hospital
- Harvard Medical School, Boston, Massachusetts, USA
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12
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Mezad-Koursh D, Klein A, Rosenblatt A, Roth S, Neudorfer M, Loewenstein A, Iglicki M, Zur D. Response to: Comment on: "Peripapillary hyperreflective ovoid mass-like structures-a novel entity as frequent cause of pseudopapilloedema in children". Eye (Lond) 2022; 36:2068. [PMID: 35066578 PMCID: PMC9499942 DOI: 10.1038/s41433-021-01908-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- Daphna Mezad-Koursh
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ainat Klein
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Rosenblatt
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Roth
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Meira Neudorfer
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Loewenstein
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Matias Iglicki
- Private Retina Office, University of Buenos Aires, Buenos Aires, Argentina
| | - Dinah Zur
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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13
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Eshun EL, Gwin JC, Ditta LC. Peripapillary hyperreflective ovoid masslike structures in a pediatric population referred for suspected papilledema. J AAPOS 2022; 26:242.e1-242.e6. [PMID: 36189468 DOI: 10.1016/j.jaapos.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/30/2022] [Accepted: 07/12/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Peripapillary hyperreflective ovoid masslike structures (PHOMS) are now considered a common cause of pseudopapilledema in the pediatric population. METHODS The medical records of all patients ≤18 years of age with PHOMS, confirmed on optical coherence tomography, seen at single pediatric neuro-ophthalmology clinic between 2017 and 2021 were reviewed retrospectively. RESULTS A total of 47 patients (35 females), with median age of 12.7 years at initial visit, were included. Of these, 24 (51%) of patients were optometry referrals. Headache was a common symptom. PHOMS were present bilaterally in all patients and were 360° around the disk in 57 of 94 eyes (61%). Patients with elevated intracranial pressure were more likely to have a reduction in the size of PHOMS at follow-up (P = 0.0133). Of the 47, 40 (85%) had diagnostic neuroimaging as a part of their papilledema workup. The retinal nerve fiber layer was thicker in patients with concomitant papilledema rather than optic disk drusen (P = 0.002) and compared with patients with PHOMS alone (P = 0.00051). CONCLUSIONS Pediatric patients with PHOMS may be referred because their clinical appearance can be suggestive of papilledema. In our study cohort, PHOMS were bilateral and frequently occurred concurrently with other ophthalmic conditions.
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Affiliation(s)
| | - J Cole Gwin
- University of Tennessee Health Science Center, Memphis, Tennessee
| | - Lauren C Ditta
- Department of Ophthalmology, University of Tennessee Health Science Center, Memphis, Tennessee; Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee; St. Jude Children's Research Hospital, Memphis, Tennessee.
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14
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Vassallo J. Comment on: 'Peripapillary hyperreflective ovoid mass-like structures-a novel entity as frequent cause of pseudopapilloedema in children'. Eye (Lond) 2022; 36:2067. [PMID: 35046549 PMCID: PMC9500004 DOI: 10.1038/s41433-021-01907-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/14/2021] [Accepted: 12/14/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- James Vassallo
- Ophthalmology Department, Mater Dei Hospital, Triq Id-Donaturi tad-Demm, Msida, MSD2090, Malta.
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Xie X, Liu T, Wang W, Tian G, Wang J, Guan J, Chen M, Wang X, Zhou Q. Clinical and Multi-Mode Imaging Features of Eyes With Peripapillary Hyperreflective Ovoid Mass-Like Structures. Front Med (Lausanne) 2022; 9:796667. [PMID: 35223899 PMCID: PMC8863604 DOI: 10.3389/fmed.2022.796667] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 01/06/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose To 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. Methods Retrospective 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. Results We 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. Conclusion EDI-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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Affiliation(s)
- Xiao Xie
- The First Clinical Medical College of Shandong University of Traditional Chinese Medicine, Jinan, China.,Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Qingdao, China.,Shandong First Medical University and Shandong Academy of Medical Sciences, Qingdao, China
| | - Tingting Liu
- Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Qingdao, China.,Shandong First Medical University and Shandong Academy of Medical Sciences, Qingdao, China.,School of Ophthalmology, Shandong First Medical University, Jinan, China
| | - Wenqi Wang
- The First Clinical Medical College of Shandong University of Traditional Chinese Medicine, Jinan, China.,Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Qingdao, China.,Shandong First Medical University and Shandong Academy of Medical Sciences, Qingdao, China
| | - Ge Tian
- Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Qingdao, China.,Shandong First Medical University and Shandong Academy of Medical Sciences, Qingdao, China.,School of Ophthalmology, Shandong First Medical University, Jinan, China
| | - Jinyan Wang
- Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Qingdao, China.,Shandong First Medical University and Shandong Academy of Medical Sciences, Qingdao, China.,School of Ophthalmology, Shandong First Medical University, Jinan, China
| | - Jitian Guan
- Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Qingdao, China.,Shandong First Medical University and Shandong Academy of Medical Sciences, Qingdao, China.,School of Ophthalmology, Shandong First Medical University, Jinan, China
| | - Meng Chen
- Zaozhuang Shizhong District People's Hospital, Zaozhuang, China
| | - Xunchang Wang
- Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Jinan, China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Qingdao, China.,Shandong First Medical University and Shandong Academy of Medical Sciences, Qingdao, China.,School of Ophthalmology, Shandong First Medical University, Jinan, China
| | - Qingjun Zhou
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Qingdao, China.,Shandong First Medical University and Shandong Academy of Medical Sciences, Qingdao, China.,School of Ophthalmology, Shandong First Medical University, Jinan, China.,Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
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Hedels C, Fantaguzzi F, Borrelli E, Sacconi R, Querques G. Multimodal Imaging of Peripapillary Hyperreflective Ovoid Mass-Like Structures. Retina 2021; 41:e75-e76. [PMID: 34483313 DOI: 10.1097/iae.0000000000003292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - Federico Fantaguzzi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; and
- Division of Head and Neck, Ophthalmology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Enrico Borrelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; and
- Division of Head and Neck, Ophthalmology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Riccardo Sacconi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; and
- Division of Head and Neck, Ophthalmology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giuseppe Querques
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; and
- Division of Head and Neck, Ophthalmology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
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