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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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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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Fraser JA, Sibony PA, Petzold A, Thaung C, Hamann S. Peripapillary Hyper-reflective Ovoid Mass-like Structure (PHOMS): An Optical Coherence Tomography Marker of Axoplasmic Stasis in the Optic Nerve Head. J Neuroophthalmol 2021; 41:431-441. [PMID: 33630781 PMCID: PMC9258618 DOI: 10.1097/wno.0000000000001203] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND With the development and widespread adoption of spectral-domain optical coherence tomography (OCT), peripapillary hyper-reflective ovoid mass-like structures (PHOMS) have become a frequent OCT finding in neuro-ophthalmic practice. Although originally assumed to represent a form of buried optic disc drusen (ODD), PHOMS differ from ODD in many important ways. The histopathological underpinnings of PHOMS are now becoming more clearly understood. EVIDENCE ACQUISITION Review of literature. RESULTS PHOMS can be broadly classified as disk edema-associated PHOMS, ODD-associated PHOMS, or anomalous disk-associated PHOMS. PHOMS are seen in many conditions, including papilledema, nonarteritic anterior ischemic optic neuropathy, central retinal vein occlusion, acute demyelinating optic neuritis, ODD, and tilted disks (myopic obliquely inserted disks) and in many cases resolve along with the underlying condition. The histopathological study of these diverse entities reveals the common feature of a bulge of optic nerve fibers herniating centrifugally over Bruch membrane opening into the peripapillary space, correlating exactly with the location, shape, and space-occupying nature of PHOMS on OCT. Because of the radial symmetry of these herniating optic nerve fibers, PHOMS are best thought of as a complete or partial torus (i.e., donut) in 3 dimensions. CONCLUSIONS PHOMS are a common but nonspecific OCT marker of axoplasmic stasis in the optic nerve head. They are not themselves ODD or ODD precursors, although they can be seen in association with ODD and a wide spectrum of other conditions. They do not exclude papilledema and often accompany it. The circumferential extent and characteristic 3D toroidal nature of a PHOMS are best appreciated by scrolling through consecutive OCT images.
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Affiliation(s)
- J. Alexander Fraser
- Department of Clinical Neurological Sciences and Department of Ophthalmology, Western University, London, Ontario, Canada
| | - Patrick A. Sibony
- Department of Ophthalmology, State University of New York at Stony Brook, Stony Brook, NY, United States
| | - Axel Petzold
- Moorfields Eye Hospital, London, UK; Department of Neurology, Amsterdam Neuroscience, VUmc MS Center Amsterdam and Dutch Expertise Centre for Neuro-ophthalmology, VU University Medical Centre, Amsterdam, The Netherlands; Institute of Neurology, University College London, London UK
| | - Caroline Thaung
- Department of Eye Pathology, UCL Institute of Ophthalmology, London, UK, and Moorfields Eye Hospital, London, UK
| | - Steffen Hamann
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Petzold A, Biousse V, Bursztyn L, Costello F, Crum A, Digre K, Fraser C, Fraser JA, Katz B, Jurkute N, Newman N, Lautrup-Battistini J, Lawlor M, Liskova P, Lorenz B, Malmqvist L, Peragallo J, Sibony P, Subramanian P, Rejdak R, Nowomiejska K, Touitou V, Warner J, Wegener M, Wong S, Yu-Wai-Man P, Hamann S. Multirater Validation of Peripapillary Hyperreflective Ovoid Mass-like Structures (PHOMS). Neuroophthalmology 2020; 44:413-414. [PMID: 33408429 PMCID: PMC7746256 DOI: 10.1080/01658107.2020.1760891] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Peripapillary hyperreflective ovoid mass-like structures (PHOMS) are a new retinal optical coherence tomography (OCT) finding. The Optic Disc Drusen Studies Consortium had made recommendations to distinguish PHOMS from true optic disc drusen (ODD) in 2018. While publications on PHOMS have increased since then, the accuracy of the definition of PHOMS and reliability of detection is unknown. In this multi-rater study, we demonstrate that the 2018 definition of PHOMS resulted in a poor multi-rater kappa of 0.356. We performed a Delphi consensus process to develop a consistent and refined definition of PHOMS with clear principles around the nature of PHOMS and how they differ from normal anatomy. Fifty explanatory teaching slides, provided as supplementary material, allowed our expert group of raters to achieve a good level of agreement (kappa 0.701, 50 OCT scans, 21 raters). We recommend adopting the refined definition for PHOMS.
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Affiliation(s)
- Axel Petzold
- Moorfields Eye Hospital NHS Foundation Trust and the National Hospital for Neurology and Neurosurgery, Queen Square, Institute of Neurology, University College London, London, UK
- Neurology and Ophthalmology, Amsterdam UMC, Locatie VUMC, Amsterdam, Netherlands
- CONTACT Axel Petzold
| | | | | | - Fiona Costello
- Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Alison Crum
- Utah System of Higher Education, Salt Lake City, Utah, USA
| | - Kathleen Digre
- Department of Neurology-Ophthalmology and Visual Science, John Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Clare Fraser
- Save Sight Institute, The University of Sydney, Sydney, North South Wales, Australia
| | - J. Alex Fraser
- Department of Clinical Neurological Sciences and Department of Ophthalmology, Western University, London, Ontario, Canada
| | - Bradley Katz
- Utah System of Higher Education, Salt Lake City, Utah, USA
| | | | - Nancy Newman
- Department of Neuro-Ophthalmology, Emory University, School of Medicine, Atlanta, Georgia, USA
| | | | - Mitchell Lawlor
- Save Sight Institute, The University of Sydney, Sydney, North South Wales, Australia
| | - Petra Liskova
- Ophthalmology, Charles University, Prague, Czech Republic
| | - Birgit Lorenz
- Ophthalmology, Justus Liebig University, Giessen, Germany
| | | | | | | | - Prem Subramanian
- Sue Anschutz-Rodgers UC Health Eye Center, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Robert Rejdak
- Department of General Opthalmology, Medical University, Lublin, Poland
| | | | - Valerie Touitou
- Groupe Hospitalier La Pitié Salpêtrière-Charles Foix, DHU Vision Et Handicaps, Paris, France
| | - Judith Warner
- Department of Ophthalmology and Visual Sciences, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | | | - Sui Wong
- Moorfields Eye Hospital City Road Campus, London, UK
| | - Patrick Yu-Wai-Man
- Cambridge University, Cambridge, UK
- Moorfields Eye Hospital NHS, Foundation Trust, Medical Retina, London, UK
| | - Steffen Hamann
- Ophthalmology, ODDS Consortium and ERN-EYE Rigshospitalet Glostrup, Denmark
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