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Liu W, Yan J, Huang H. Peripapillary hyperreflective ovoid mass-like structures with cystoid macular edema: a case report. BMC Ophthalmol 2024; 24:247. [PMID: 38862962 PMCID: PMC11165800 DOI: 10.1186/s12886-024-03509-3] [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: 01/20/2024] [Accepted: 06/03/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Peripapillary hyperreflective ovoid mass-like structures (PHOMS) are newly characterized lesions wedged around the optic discs, which used to be misdiagnosed. Better understanding and identifying PHOMS are important for monitoring the condition of optic nerve. CASE PRESENTATION A young female presented to the ophthalmic clinic with blurred vision of both eyes. Protrusions resembling "C-shaped donut" were found circling the optic discs bilaterally. These lesions were homogenous hyperreflective on OCT, while they were also hypoautofluorescent and hypoechogenic. Meanwhile, cystoid macular edema (CME) was also identified in both eyes. The patient was then diagnosed as PHOMS with CME. A short-term glucocorticoids therapy was prescribed systemically. The logMAR best-corrected visual acuity (BCVA) of both eyes reached 0.0 in 4 months with recovery of CME, while the PHOMS remained. CONCLUSIONS There is currently no report on PHOMS with CME. More attentions should be paid to PHOMS, for they are potential biomarkers for axoplasmic stasis involved in different diseases of the optic nerve.
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Affiliation(s)
- Wei Liu
- Department of Ophthalmology, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, 116 South Changjiang Road, Zhuzhou, 412000, China
| | - Jianjun Yan
- Department of Ophthalmology, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, 116 South Changjiang Road, Zhuzhou, 412000, China
| | - Hao Huang
- Department of Ophthalmology, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, 116 South Changjiang Road, Zhuzhou, 412000, China.
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-Sen University, 54 South Xianlie Road, Guangzhou, 510060, China.
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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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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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González Martín-Moro J. PHOMS: Time to change the acronym? ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2024; 99:89-90. [PMID: 37951352 DOI: 10.1016/j.oftale.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/07/2023] [Indexed: 11/14/2023]
Affiliation(s)
- J González Martín-Moro
- Department of Ophthalmology, University Hospital of Henares, Coslada, Madrid, Spain; University Francisco de Vitoria, Madrid, Spain.
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5
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Chen C. Correlation of structure with function: The role of optical coherence tomography in neuro-ophthalmology. Clin Exp Ophthalmol 2024; 52:135-136. [PMID: 38454252 DOI: 10.1111/ceo.14360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 01/24/2024] [Indexed: 03/09/2024]
Affiliation(s)
- Celia Chen
- Department of Ophthalmology, Flinders Medical Centre and Flinders University, Adelaide, South Australia, Australia
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Chang YH, Staffa SJ, Yavuz Saricay L, Zurakowski D, Gise R, Dagi LR. Sensitivity, Specificity, and Cutoff Identifying Optic Atrophy by Macular Ganglion Cell Layer Volume in Syndromic Craniosynostosis. Ophthalmology 2024; 131:341-348. [PMID: 37742723 DOI: 10.1016/j.ophtha.2023.09.022] [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: 07/19/2023] [Revised: 08/31/2023] [Accepted: 09/18/2023] [Indexed: 09/26/2023] Open
Abstract
PURPOSE To determine the sensitivity, specificity, and cutoff of macular ganglion cell layer (GCL) volume consistent with optic atrophy in children with syndromic craniosynostosis and to investigate factors independently associated with reduction in GCL volume. DESIGN Retrospective cross-sectional study. PARTICIPANTS Patients with syndromic craniosynostosis evaluated at Boston Children's Hospital (2010-2022) with reliable macular OCT scans. METHODS The latest ophthalmic examination that included OCT macula scans was identified. Age at examination, sex, ethnicity, best-corrected logarithm of the minimum angle of resolution (logMAR) visual acuity, cycloplegic refraction, and funduscopic optic nerve appearance were recorded in addition to history of primary or recurrent elevation in intracranial pressure (ICP), Chiari malformation, and obstructive sleep apnea (OSA). Spectral-domain OCT software quantified segmentation of macula retinal layers and was checked manually. MAIN OUTCOME MEASURES The primary outcome was determining sensitivity, specificity, and optimal cutoff of GCL volume consistent with optic atrophy. The secondary outcome was determining whether previously elevated ICP, OSA, Chiari malformation, craniosynostosis diagnosis, logMAR visual acuity, age, or sex were independently associated with lower GCL volume. RESULTS Median age at examination was 11.9 years (interquartile range, 8.5-14.8 years). Fifty-eight of 61 patients (112 eyes) had reliable macula scans, 74% were female, and syndromes represented were Apert (n = 14), Crouzon (n = 17), Muenke (n = 6), Pfeiffer (n = 6), and Saethre-Chotzen (n = 15). Optimal cutoff identifying optic atrophy was a GCL volume < 1.02 mm3 with a sensitivity of 83% and specificity of 77%. Univariate analysis demonstrated that significantly lower macular GCL volume was associated with optic atrophy on fundus examination (P < 0.001), Apert syndrome (P < 0.001), history of elevated ICP (P = 0.015), Chiari malformation (P = 0.001), OSA (P < 0.001), male sex (P = 0.027), and worse logMAR visual acuity (P < 0.001). Multivariable median regression analysis confirmed that only OSA (P = 0.005), optic atrophy on fundus examination (P = 0.003), and worse logMAR visual acuity (P = 0.042) were independently associated with lower GCL volume. CONCLUSIONS Surveillance for optic atrophy by GCL volume may be useful in a population where cognitive skills can limit acquisition of other key ophthalmic measures. It is noteworthy that OSA is also associated with lower GLC volume in this population. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Yoon-Hee Chang
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Leyla Yavuz Saricay
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - David Zurakowski
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ryan Gise
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Linda R Dagi
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
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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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8
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Wang F. Case Report: Optic Disc Melanocytoma with PHOMS-Minimum Intensity Projection Image. Int Med Case Rep J 2024; 17:137-141. [PMID: 38404753 PMCID: PMC10888016 DOI: 10.2147/imcrj.s444050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/13/2024] [Indexed: 02/27/2024] Open
Abstract
Introduction Optic disc melanocytoma (ODMC) with peripapillary hyperreflective ovoid mass-like structures (PHOMS) is rare. This study reports a case of the characteristics of multimodal imaging and Minimum intensity projection (Min-IP) images. Methods A 25-year-old male patient was referred to our hospital due to the presence of a dark pigmented tumor located in the optic disc area of his left eye. The patient exhibited normal pupillary reactions and had a best corrected visual acuity of 1.0 (decimal) in both eyes. This patient underwent multimodal retinal imaging examination including color fundus photograph (CFP), B-scan ultrasonography, Fundus autofluorescence (FAF), SD-OCT (spectral-domain optical coherence tomography), OCTA (optical coherence tomography angiography), en-face Min-IP image and fluorescein angiography (FA). Results CFP revealed a slightly elevated mass lesion in the inferior quadrant of the left optic disc, the lesion appeared black to dark brown in color. B-scan ultrasonography of the left eye confirmed the presence of a hyperechoic small dome-shaped lesion. Fundus autofluorescence (FAF) analysis revealed complete hypofluorescence in this area. SD-OCT (spectral-domain optical coherence tomography) and OCTA (optical coherence tomography angiography) with Min-IP were performed over the tumor and its surrounding areas. SD-OCT showed an elevated tumor mass arising from the optic disc with increased reflectivity. PHOMS appeared ovoid in shape on B-scan OCT image. PHOMS appeared peripapillary hyperreflective bright areas on en-face Min-IP image corresponding to PHOMS on B-scan OCT image. The fluorescein angiography (FA) showed the staining of PHOMS. A diagnosis of optic disc melanocytoma with PHOMS was established prompting the patient to be advised for regular follow-up. Conclusion The optic disc melanocytoma with PHOMS is a rare benign ocular lesion that requires minimal active intervention, but demands a lifetime follow-up. The multimodal imaging and Min-IP images have clinical diagnostic value.
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Affiliation(s)
- Fubin Wang
- Department of Ophthalmology, Shanghai Bright Eye Hospital, Shanghai, 200336, People’s Republic of China
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9
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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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10
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Yiangou A, Mollan SP, Sinclair AJ. Idiopathic intracranial hypertension: a step change in understanding the disease mechanisms. Nat Rev Neurol 2023; 19:769-785. [PMID: 37957260 DOI: 10.1038/s41582-023-00893-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 11/15/2023]
Abstract
The understanding of idiopathic intracranial hypertension (IIH) has evolved over the past few years. Previously, IIH was considered a disease exclusively affecting the neuro-ophthalmic axis, characterized by raised intracranial pressure, headache and papilloedema, and resulting in the risk of severe and permanent visual loss and life-changing disabling headaches. Recent advances have begun to redefine IIH as a probable metabolic disease involving a range of systemic manifestations. More than 95% of individuals affected by the disease are women of reproductive age with obesity. The incidence is rapidly rising and parallels the escalating worldwide obesity rates. Contemporary insights identify associations with insulin resistance, type 2 diabetes and a twofold increased risk of cardiovascular disease in excess of that driven by obesity alone. Adipose distribution in people with IIH, like that in other metabolic diseases, is preferentially centripetal and is associated with changes in intracranial pressure. Evidence now demonstrates adipose tissue dysfunction in people with IIH, involving transcriptional and metabolic priming for lipogenesis and weight gain. Hormonal perturbations are also observed, including a unique phenotype of androgen excess that promotes cerebrospinal fluid secretion. Knowledge of these additional disease features is driving research into novel therapeutic targets and altering the approach to multidisciplinary care.
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Affiliation(s)
- Andreas Yiangou
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Neurology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Susan P Mollan
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Birmingham Neuro-Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Alexandra J Sinclair
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
- Department of Neurology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK.
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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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Bassi ST, Verma A. Optical Coherence Tomography in a Morning Glory Disc Anomaly with a Peripapillary Choroidal Neovascular Membrane. Neuroophthalmology 2023; 48:27-29. [PMID: 38357615 PMCID: PMC10863349 DOI: 10.1080/01658107.2023.2255665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/22/2023] [Indexed: 02/16/2024] Open
Abstract
The purpose of this case report is to describe the optical coherence tomography (OCT) features of a peripapillary choroidal neovascular membrane (PPCNVM) in an eye with morning glory disc anomaly (MGDA). A PPCNVM appears as a hyper-reflective mass in the peripapillary area. It should be distinguished from peripapillary hyper-reflective ovoid mass-like structures, which are markers of axoplasmic flow stasis. This case report describes the distinguishing features between the two. The presence of intraretinal cystic spaces are indicative of an active PPCNVM. In conclusion, MGDA can be associated with PPCNVM and OCT can be used in its detection.
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Affiliation(s)
| | - Aditya Verma
- Vitreoretinal Services, Sankara Nethralaya, Chennai, India
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13
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Aziria A, Philibert M, Deschamps R, Vignal C, Hage R. Are PHOMS a clinical sign of optic neuritis? Eye (Lond) 2023; 37:2776-2780. [PMID: 36721052 PMCID: PMC10482841 DOI: 10.1038/s41433-023-02419-w] [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: 04/03/2022] [Revised: 12/05/2022] [Accepted: 01/23/2023] [Indexed: 02/02/2023] Open
Abstract
PURPOSE Assess the prevalence and evolution of PHOMS in optic neuritis. METHODS We analysed the medical files of 126 patients included in the OCTON cohort. Patients' medical files, digital retinal images and OCT examinations were reviewed, searching for optic nerve head oedema and PHOMS at the initial presentation and during the follow-up. RESULTS We included 102 patients in the final analysis. Twenty-nine (29) eyes had optic nerve head oedema at the initial presentation. PHOMS were found to be present in 8 eyes affected with optic neuritis. All cases of PHOMS were associated with optic nerve head oedema. All the PHOMS decreased in size and disappeared with the improvement of the oedema. DISCUSSION Our results show that PHOMS is not a common sign of optic neuritis. We didn't observe any case of PHOMS in the absence of optic nerve head oedema in eyes with optic neuritis. PHOMS seem to be a rare sign of optic neuritis associated to optic nerve head oedema, and they tend to disappear with the improvement of the optic nerve head oedema. We suggest that the presence of PHOMS in optic neuritis eyes with no optic nerve oedema should be a considered warning sign.
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Affiliation(s)
- Ahmed Aziria
- Rothschild Foundation Hospital, department of Neuro-Ophthalmology, 29 rue Manin, 75940, Paris, Cedex 19, France.
- Sorbonne Université, Faculté de Médecine, 91 Boulevard de l' l'Hôpital, 75013, Paris, France.
| | - Manon Philibert
- Rothschild Foundation Hospital, department of Neuro-Ophthalmology, 29 rue Manin, 75940, Paris, Cedex 19, France
| | - Romain Deschamps
- Rothschild Foundation Hospital, department of neurology, 29 rue Manin, 75940, Paris, Cedex 19, France
| | - Catherine Vignal
- Rothschild Foundation Hospital, department of Neuro-Ophthalmology, 29 rue Manin, 75940, Paris, Cedex 19, France
| | - Rabih Hage
- Rothschild Foundation Hospital, department of Neuro-Ophthalmology, 29 rue Manin, 75940, Paris, Cedex 19, France
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14
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Naxer S, Schittkowski M. [OCT in Neuroophthalmology]. Klin Monbl Augenheilkd 2023. [PMID: 37236234 DOI: 10.1055/a-1978-5408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Optical coherence tomography (OCT) has become the most important innovation in ophthalmology over the last 30 years and is used routinely, especially in the diagnosis of retinal and glaucomatous diseases. It is fast, non-invasive and reproducible. Since the procedures can offer such a high resolution that the individual retinal layers can be visualised and segmented, this examination technique has also found its way into neuroophthalmology. Especially the peripapillary nerve fibre layer (RNFL) and the ganglion cell layer (GCL) provide valuable diagnostic and prognostic information in cases of visual pathway disease and morphologically unexplained visual disorders. OCT is helpful in determining the cause of optic disc swelling and EDI-OCT can reliably detect buried, non-calcified drusen. This article is intended to provide the reader with an overview of current and future applications of OCT in neuroophthalmology and knowledge of possible pitfalls.
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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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Nij Bijvank J, Maillette de Buy Wenniger L, de Graaf P, Petzold A. Clinical review of retinotopy. Br J Ophthalmol 2023; 107:304-312. [PMID: 34887243 DOI: 10.1136/bjophthalmol-2021-320563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 11/14/2021] [Indexed: 11/03/2022]
Abstract
Two observations made 29 years apart are the cornerstones of this review on the contributions of Dr Gordon T. Plant to understanding pathology affecting the optic nerve. The first observation laid the anatomical basis in 1990 for the interpretation of optical coherence tomography (OCT) findings in 2009. Retinal OCT offers clinicians detailed in vivo structural imaging of individual retinal layers. This has led to novel observations which were impossible to make using ophthalmoscopy. The technique also helps to re-introduce the anatomically grounded concept of retinotopy to clinical practise. This review employs illustrations of the anatomical basis for retinotopy through detailed translational histological studies and multimodal brain-eye imaging studies. The paths of the prelaminar and postlaminar axons forming the optic nerve and their postsynaptic path from the dorsal lateral geniculate nucleus to the primary visual cortex in humans are described. With the mapped neuroanatomy in mind we use OCT-MRI pairings to discuss the patterns of neurodegeneration in eye and brain that are a consequence of the hard wired retinotopy: anterograde and retrograde axonal degeneration which can, within the visual system, propagate trans-synaptically. The technical advances of OCT and MRI for the first time enable us to trace axonal degeneration through the entire visual system at spectacular resolution. In conclusion, the neuroanatomical insights provided by the combination of OCT and MRI allows us to separate incidental findings from sinister pathology and provides new opportunities to tailor and monitor novel neuroprotective strategies.
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Affiliation(s)
- Jenny Nij Bijvank
- Departments of Ophthalmology and Neurology, Expertise Centre Neuro-ophthalmology, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | | | - Pim de Graaf
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Department of Neurology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Axel Petzold
- Departments of Ophthalmology and Neurology, Expertise Centre Neuro-ophthalmology, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands .,Moorfields Eye Hospital, City Road; The National Hospital for Neurology and Neurosurgery and the UCL Institute of Neurology, Queen Square, London, London, UK
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17
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Vela JI, Perich S, Bulnes V, Loscos I, Baradad M. Bilateral Progressive Optic Neuropathy in a Patient with Familial Amyloid Polyneuropathy: Amyloid Deposits in the Optic Nerve Head? Neuroophthalmology 2023; 47:164-170. [PMID: 37398503 PMCID: PMC10312026 DOI: 10.1080/01658107.2023.2176890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 01/26/2023] [Accepted: 01/30/2023] [Indexed: 02/18/2023] Open
Abstract
Familial amyloid polyneuropathy is a rare autosomal dominant hereditary disease. Optic nerve involvement is frequently observed secondary to uncontrolled glaucoma but, rarely, an ischaemic optic neuropathy can occur. In this case report we describe a patient who presented with bilateral progressive visual loss and constriction of his visual fields. Fundus examination showed intense paleness of both optic discs with elevated, poorly defined margins that seemed to be infiltrated. Fundus autofluorescence and enhanced-depth imaging optical coherence tomography ruled out the presence of optic disc drusen. Orbital magnetic resonance imaging ruled out any sign of orbital compression, inflammation or infiltration of the optic nerve. The mechanism of small vessel amyloid infiltration and a possible vessel compression by amyloid in the optic nerve head is discussed.
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Affiliation(s)
- José Ignacio Vela
- Department of Opthalmology, Hospital de la Santa Creu i Sant Pau, Sant, Barcelona, Spain
- Department of Ophthalmology, Institut Condal d’Oftalmologia, Barcelona, Spain
- Department of Surgery, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Institut d´Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
| | - Sandra Perich
- Department of Opthalmology, Hospital de la Santa Creu i Sant Pau, Sant, Barcelona, Spain
| | - Victoria Bulnes
- Department of Opthalmology, Hospital de la Santa Creu i Sant Pau, Sant, Barcelona, Spain
| | - Irene Loscos
- Department of Opthalmology, Hospital de la Santa Creu i Sant Pau, Sant, Barcelona, Spain
| | - María Baradad
- Department of Opthalmology, Hospital de la Santa Creu i Sant Pau, Sant, Barcelona, Spain
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18
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Bouthour W, Biousse V, Newman NJ. Diagnosis of Optic Disc Oedema: Fundus Features, Ocular Imaging Findings, and Artificial Intelligence. Neuroophthalmology 2023; 47:177-192. [PMID: 37434667 PMCID: PMC10332214 DOI: 10.1080/01658107.2023.2176522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/12/2023] [Accepted: 01/29/2023] [Indexed: 02/18/2023] Open
Abstract
Optic disc swelling is a manifestation of a broad range of processes affecting the optic nerve head and/or the anterior segment of the optic nerve. Accurately diagnosing optic disc oedema, grading its severity, and recognising its cause, is crucial in order to treat patients in a timely manner and limit vision loss. Some ocular fundus features, in light of a patient's history and visual symptoms, may suggest a specific mechanism or aetiology of the visible disc oedema, but current criteria can at most enable an educated guess as to the most likely cause. In many cases only the clinical evolution and ancillary testing can inform the exact diagnosis. The development of ocular fundus imaging, including colour fundus photography, fluorescein angiography, optical coherence tomography, and multimodal imaging, has provided assistance in quantifying swelling, distinguishing true optic disc oedema from pseudo-optic disc oedema, and differentiating among the numerous causes of acute optic disc oedema. However, the diagnosis of disc oedema is often delayed or not made in busy emergency departments and outpatient neurology clinics. Indeed, most non-eye care providers are not able to accurately perform ocular fundus examination, increasing the risk of diagnostic errors in acute neurological settings. The implementation of non-mydriatic fundus photography and artificial intelligence technology in the diagnostic process addresses these important gaps in clinical practice.
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Affiliation(s)
- Walid Bouthour
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Valérie Biousse
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nancy J. Newman
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
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19
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Gernert JA, Wicklein R, Hemmer B, Kümpfel T, Knier B, Havla J. Peripapillary hyper-reflective ovoid mass-like structures (PHOMS) in AQP4-IgG-positive neuromyelitis optica spectrum disease (NMOSD) and MOG-IgG-associated disease (MOGAD). J Neurol 2023; 270:1135-1140. [PMID: 36245037 PMCID: PMC9886610 DOI: 10.1007/s00415-022-11381-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Peripapillary hyperreflective ovoid mass-like structures (PHOMS) have recently been described as new optical coherence tomography (OCT) marker. It is not yet clear whether the occurrence of PHOMS is disease-specific or disease-spanning. PHOMS have been described in 16-18% of patients with multiple sclerosis (MS). Currently, no data on the prevalence of PHOMS in other demyelinating diseases including aquaporine-4-IgG-positive neuromyelitis optica spectrum disease (AQP4 + NMOSD) or myelin oligodendrocyte glycoprotein-IgG-associated disease (MOGAD) are reported. METHODS We performed a cross-sectional, retrospective spectral domain OCT study evaluating the frequency of PHOMS in AQP4 + NMOSD (n = 47) and MOGAD (n = 44) patients. To test the association with retinal neuroaxonal damage, we compared demographic and clinical data as well as retinal layer thicknesses between eyes with vs. eyes without PHOMS. RESULTS PHOMS were detected in 17% of AQP4 + NMOSD and 14% of MOGAD patients. Intra-cohort analysis revealed that AQP4 + NMOSD patients with PHOMS were significantly older [mean (years): 57.5 vs. 50.0; p value = 0.04]. We found no association of PHOMS with retinal neuroaxonal degeneration. In addition, in subjects with only one eye affected by PHOMS compared with the unaffected fellow eye, no differences in retinal parameters were observed (n = 4). CONCLUSIONS In summary, we found PHOMS in 17% of AQP4 + NMOSD and 14% of MOGAD patients. This is comparable to the prevalence of published MS PHOMS data. Therefore, a disease-specific occurrence of PHOMS is unlikely. Interestingly, PHOMS do not seem to depend on retinal neuroaxonal degeneration.
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Affiliation(s)
- Jonathan A Gernert
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians University Munich, Munich, Germany
| | - Rebecca Wicklein
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Data Integration for Future Medicine (DIFUTURE) Consortium, Munich, Germany
| | - Bernhard Hemmer
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Data Integration for Future Medicine (DIFUTURE) Consortium, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Tania Kümpfel
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians University Munich, Munich, Germany
- Data Integration for Future Medicine (DIFUTURE) Consortium, Munich, Germany
| | - Benjamin Knier
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Data Integration for Future Medicine (DIFUTURE) Consortium, Munich, Germany
| | - Joachim Havla
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians University Munich, Munich, Germany.
- Data Integration for Future Medicine (DIFUTURE) Consortium, Munich, Germany.
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20
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Girard MJA, Panda S, Tun TA, Wibroe EA, Najjar RP, Aung T, Thiéry AH, Hamann S, Fraser C, Milea D. Discriminating Between Papilledema and Optic Disc Drusen Using 3D Structural Analysis of the Optic Nerve Head. Neurology 2023; 100:e192-e202. [PMID: 36175153 DOI: 10.1212/wnl.0000000000201350] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 08/19/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The distinction of papilledema from other optic nerve head (ONH) lesions mimicking papilledema, such as optic disc drusen (ODD), can be difficult in clinical practice. We aimed the following: (1) to develop a deep learning algorithm to automatically identify major structures of the ONH in 3-dimensional (3D) optical coherence tomography (OCT) scans and (2) to exploit such information to robustly differentiate among ODD, papilledema, and healthy ONHs. METHODS This was a cross-sectional comparative study of patients from 3 sites (Singapore, Denmark, and Australia) with confirmed ODD, those with papilledema due to raised intracranial pressure, and healthy controls. Raster scans of the ONH were acquired using OCT imaging and then processed to improve deep-tissue visibility. First, a deep learning algorithm was developed to identify major ONH tissues and ODD regions. The performance of our algorithm was assessed using the Dice coefficient. Second, a classification algorithm (random forest) was designed to perform 3-class classifications (1: ODD, 2: papilledema, and 3: healthy ONHs) strictly from their drusen and prelamina swelling scores (calculated from the segmentations). To assess performance, we reported the area under the receiver operating characteristic curve for each class. RESULTS A total of 241 patients (256 imaged ONHs, including 105 ODD, 51 papilledema, and 100 healthy ONHs) were retrospectively included in this study. Using OCT images of the ONH, our segmentation algorithm was able to isolate neural and connective tissues and ODD regions/conglomerates whenever present. This was confirmed by an averaged Dice coefficient of 0.93 ± 0.03 on the test set, corresponding to good segmentation performance. Classification was achieved with high AUCs, that is, 0.99 ± 0.001 for the detection of ODD, 0.99 ± 0.005 for the detection of papilledema, and 0.98 ± 0.01 for the detection of healthy ONHs. DISCUSSION Our artificial intelligence approach can discriminate ODD from papilledema, strictly using a single OCT scan of the ONH. Our classification performance was very good in the studied population, with the caveat that validation in a much larger population is warranted. Our approach may have the potential to establish OCT imaging as one of the mainstays of diagnostic imaging for ONH disorders in neuro-ophthalmology, in addition to fundus photography.
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Affiliation(s)
- Michaël J A Girard
- From the Ophthalmic Engineering & Innovation Laboratory (M.J.A.G., S.P.), Singapore Eye Research Institute (T.A.T., R.P.N., T.A., D.M.), Singapore National Eye Centre; Duke-NUS Graduate Medical School (M.J.A.G., T.A.T., R.P.N., T.A., D.M.), Singapore; Institute for Molecular and Clinical Ophthalmology (M.J.A.G.), Basel, Switzerland; Department of Ophthalmology (E.A.W., S.H.), Rigshospitalet, University of Copenhagen, Denmark; Yong Loo Lin School of Medicine (R.P.N., T.A.), and Department of Statistics and Applied Probability (A.H.T.), National University of Singapore; and Save Sight Institute (C.F.), Faculty of Health and Medicine, The University of Sydney, New South Wales, Australia.
| | - Satish Panda
- From the Ophthalmic Engineering & Innovation Laboratory (M.J.A.G., S.P.), Singapore Eye Research Institute (T.A.T., R.P.N., T.A., D.M.), Singapore National Eye Centre; Duke-NUS Graduate Medical School (M.J.A.G., T.A.T., R.P.N., T.A., D.M.), Singapore; Institute for Molecular and Clinical Ophthalmology (M.J.A.G.), Basel, Switzerland; Department of Ophthalmology (E.A.W., S.H.), Rigshospitalet, University of Copenhagen, Denmark; Yong Loo Lin School of Medicine (R.P.N., T.A.), and Department of Statistics and Applied Probability (A.H.T.), National University of Singapore; and Save Sight Institute (C.F.), Faculty of Health and Medicine, The University of Sydney, New South Wales, Australia
| | - Tin Aung Tun
- From the Ophthalmic Engineering & Innovation Laboratory (M.J.A.G., S.P.), Singapore Eye Research Institute (T.A.T., R.P.N., T.A., D.M.), Singapore National Eye Centre; Duke-NUS Graduate Medical School (M.J.A.G., T.A.T., R.P.N., T.A., D.M.), Singapore; Institute for Molecular and Clinical Ophthalmology (M.J.A.G.), Basel, Switzerland; Department of Ophthalmology (E.A.W., S.H.), Rigshospitalet, University of Copenhagen, Denmark; Yong Loo Lin School of Medicine (R.P.N., T.A.), and Department of Statistics and Applied Probability (A.H.T.), National University of Singapore; and Save Sight Institute (C.F.), Faculty of Health and Medicine, The University of Sydney, New South Wales, Australia
| | - Elisabeth A Wibroe
- From the Ophthalmic Engineering & Innovation Laboratory (M.J.A.G., S.P.), Singapore Eye Research Institute (T.A.T., R.P.N., T.A., D.M.), Singapore National Eye Centre; Duke-NUS Graduate Medical School (M.J.A.G., T.A.T., R.P.N., T.A., D.M.), Singapore; Institute for Molecular and Clinical Ophthalmology (M.J.A.G.), Basel, Switzerland; Department of Ophthalmology (E.A.W., S.H.), Rigshospitalet, University of Copenhagen, Denmark; Yong Loo Lin School of Medicine (R.P.N., T.A.), and Department of Statistics and Applied Probability (A.H.T.), National University of Singapore; and Save Sight Institute (C.F.), Faculty of Health and Medicine, The University of Sydney, New South Wales, Australia
| | - Raymond P Najjar
- From the Ophthalmic Engineering & Innovation Laboratory (M.J.A.G., S.P.), Singapore Eye Research Institute (T.A.T., R.P.N., T.A., D.M.), Singapore National Eye Centre; Duke-NUS Graduate Medical School (M.J.A.G., T.A.T., R.P.N., T.A., D.M.), Singapore; Institute for Molecular and Clinical Ophthalmology (M.J.A.G.), Basel, Switzerland; Department of Ophthalmology (E.A.W., S.H.), Rigshospitalet, University of Copenhagen, Denmark; Yong Loo Lin School of Medicine (R.P.N., T.A.), and Department of Statistics and Applied Probability (A.H.T.), National University of Singapore; and Save Sight Institute (C.F.), Faculty of Health and Medicine, The University of Sydney, New South Wales, Australia
| | - Tin Aung
- From the Ophthalmic Engineering & Innovation Laboratory (M.J.A.G., S.P.), Singapore Eye Research Institute (T.A.T., R.P.N., T.A., D.M.), Singapore National Eye Centre; Duke-NUS Graduate Medical School (M.J.A.G., T.A.T., R.P.N., T.A., D.M.), Singapore; Institute for Molecular and Clinical Ophthalmology (M.J.A.G.), Basel, Switzerland; Department of Ophthalmology (E.A.W., S.H.), Rigshospitalet, University of Copenhagen, Denmark; Yong Loo Lin School of Medicine (R.P.N., T.A.), and Department of Statistics and Applied Probability (A.H.T.), National University of Singapore; and Save Sight Institute (C.F.), Faculty of Health and Medicine, The University of Sydney, New South Wales, Australia
| | - Alexandre H Thiéry
- From the Ophthalmic Engineering & Innovation Laboratory (M.J.A.G., S.P.), Singapore Eye Research Institute (T.A.T., R.P.N., T.A., D.M.), Singapore National Eye Centre; Duke-NUS Graduate Medical School (M.J.A.G., T.A.T., R.P.N., T.A., D.M.), Singapore; Institute for Molecular and Clinical Ophthalmology (M.J.A.G.), Basel, Switzerland; Department of Ophthalmology (E.A.W., S.H.), Rigshospitalet, University of Copenhagen, Denmark; Yong Loo Lin School of Medicine (R.P.N., T.A.), and Department of Statistics and Applied Probability (A.H.T.), National University of Singapore; and Save Sight Institute (C.F.), Faculty of Health and Medicine, The University of Sydney, New South Wales, Australia
| | - Steffen Hamann
- From the Ophthalmic Engineering & Innovation Laboratory (M.J.A.G., S.P.), Singapore Eye Research Institute (T.A.T., R.P.N., T.A., D.M.), Singapore National Eye Centre; Duke-NUS Graduate Medical School (M.J.A.G., T.A.T., R.P.N., T.A., D.M.), Singapore; Institute for Molecular and Clinical Ophthalmology (M.J.A.G.), Basel, Switzerland; Department of Ophthalmology (E.A.W., S.H.), Rigshospitalet, University of Copenhagen, Denmark; Yong Loo Lin School of Medicine (R.P.N., T.A.), and Department of Statistics and Applied Probability (A.H.T.), National University of Singapore; and Save Sight Institute (C.F.), Faculty of Health and Medicine, The University of Sydney, New South Wales, Australia
| | - Clare Fraser
- From the Ophthalmic Engineering & Innovation Laboratory (M.J.A.G., S.P.), Singapore Eye Research Institute (T.A.T., R.P.N., T.A., D.M.), Singapore National Eye Centre; Duke-NUS Graduate Medical School (M.J.A.G., T.A.T., R.P.N., T.A., D.M.), Singapore; Institute for Molecular and Clinical Ophthalmology (M.J.A.G.), Basel, Switzerland; Department of Ophthalmology (E.A.W., S.H.), Rigshospitalet, University of Copenhagen, Denmark; Yong Loo Lin School of Medicine (R.P.N., T.A.), and Department of Statistics and Applied Probability (A.H.T.), National University of Singapore; and Save Sight Institute (C.F.), Faculty of Health and Medicine, The University of Sydney, New South Wales, Australia
| | - Dan Milea
- From the Ophthalmic Engineering & Innovation Laboratory (M.J.A.G., S.P.), Singapore Eye Research Institute (T.A.T., R.P.N., T.A., D.M.), Singapore National Eye Centre; Duke-NUS Graduate Medical School (M.J.A.G., T.A.T., R.P.N., T.A., D.M.), Singapore; Institute for Molecular and Clinical Ophthalmology (M.J.A.G.), Basel, Switzerland; Department of Ophthalmology (E.A.W., S.H.), Rigshospitalet, University of Copenhagen, Denmark; Yong Loo Lin School of Medicine (R.P.N., T.A.), and Department of Statistics and Applied Probability (A.H.T.), National University of Singapore; and Save Sight Institute (C.F.), Faculty of Health and Medicine, The University of Sydney, New South Wales, Australia
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21
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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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22
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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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23
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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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24
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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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Biousse V, Danesh-Meyer HV, Saindane AM, Lamirel C, Newman NJ. Imaging of the optic nerve: technological advances and future prospects. Lancet Neurol 2022; 21:1135-1150. [DOI: 10.1016/s1474-4422(22)00173-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 04/06/2022] [Accepted: 04/13/2022] [Indexed: 01/02/2023]
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Optic Nerve Drusen Evaluation: A Comparison between Ultrasound and OCT. J Clin Med 2022; 11:jcm11133715. [PMID: 35806999 PMCID: PMC9267746 DOI: 10.3390/jcm11133715] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 02/02/2023] Open
Abstract
This observational study compared optic coherence tomography (OCT) and B-scan in the detection of optic disc drusen. In total, 86 eyes of 50 patients with optic disc drusen (ODD) (36 bilateral) with a mean age of 34.68 ± 23.81 years, and 54 eyes of 27 patients with papilledema, with a mean age of 35.42 years ± 17.47, were examined. Patients with ODD, diagnosed with ultrasound, underwent spectral-domain OCT evaluation. With US, 28 ODD cases were classified as large (4 buried and 24 superficial), 58 were classified as point-like (6 buried, 49 superficial and 3 mixed). Then, all patients underwent OCT. OCT was able to detect the presence of ODD and/or peripapillary hyperreflective ovoid mass structure (PHOMS) in 69 eyes (p < 0.001). In particular, 7 eyes (8.14%) showed the presence of ODD alone, 25 eyes (29.07%) showed only PHOMS and 37 eyes (43.02%) showed ODD and PHOMS. In 17 eyes (19.77%) no ODD or PHOMS were detected. In the papilledema group, no ODD were observed with both US and OCT. OCT showed the presence of drusen or similar lesions in only 80.23% of the cases highlighted by the US scan, so it does not allow for certain ODD diagnoses, especially in the case of buried ODD.
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Optic Nerve Head Anatomy and Vascular Risk Factors in Patients with Optic Disc Drusen Associated Anterior Ischemic Optic Neuropathy. Am J Ophthalmol 2022; 242:156-164. [DOI: 10.1016/j.ajo.2022.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/09/2022] [Accepted: 06/16/2022] [Indexed: 11/22/2022]
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Jørgensen M, Malmqvist L, Hansen AE, Fraser JA, Hamann S. Volumetric Measurement of Peripapillary Hyperreflective Ovoid Masslike Structures in Patients with Optic Disc Drusen. OPHTHALMOLOGY SCIENCE 2022; 2:100096. [PMID: 36246173 PMCID: PMC9562331 DOI: 10.1016/j.xops.2021.100096] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/17/2021] [Accepted: 11/23/2021] [Indexed: 01/06/2023]
Abstract
Purpose To develop a method to determine the volume of peripapillary hyperreflective ovoid masslike structures (PHOMS) and to examine the correlation between PHOMS and anatomic optic nerve head characteristics in a large cohort of patients with optic disc drusen (ODD). Design Retrospective, observational study of patients with ODD. Participants Patients with ODD seen in a 3-year period. Methods We determined the prevalence of PHOMS. We then developed a method to calculate the volume of PHOMS and measured this in all patients where radial scans on OCT were available. We analyzed the correlation between PHOMS volume and patient age, size of Bruch’s membrane opening (BMO), ODD visibility, and anatomic location of ODD in the optic nerve. Main Outcome Measures Prevalence and characteristics of PHOMS in patients with ODD. Results In 247 (77%) eyes with ODD, PHOMS were found. Among these, 80% were in the first decade of life, 87% were in the second decade, 89% were in the third decade, 85% were in the fourth decade, 74% were in the fifth decade, 73% were in the sixth decade, 58% were in the seventh decade, 40% were in the eighth decade, and 0% were in the ninth decade. The ophthalmoscopic visibility of ODD increased with age. The volume of PHOMS decreased with age, but with no correlation to the size of BMO. The median volume of PHOMS was 0.27 mm3 (interquartile range [IQR], 0.13–0.49 mm3). Predominantly, PHOMS were observed in the nasal peripapillary area (87.5% nasal, 78.5% superior, 67% inferior, and 63.5% temporal). Conclusions In patients with ODD, PHOMS are seen frequently, with the highest prevalence in younger individuals. The volume of PHOMS decreases with age, and PHOMS are seen more frequently in patients with superficial ODD.
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Affiliation(s)
- Morten Jørgensen
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Glostrup, Denmark
| | - Lasse Malmqvist
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Glostrup, Denmark
| | - Alexander E. Hansen
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Glostrup, Denmark
| | - J. Alexander Fraser
- Departments of Clinical Neurological Sciences and Ophthalmology, Western University, London, Canada
| | - Steffen Hamann
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Glostrup, Denmark
- Correspondence: Steffen Hamann, MD, PhD, Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Valdemar Hansens Vej 1-23, 2600 Glostrup, Denmark.
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Petzold A. Neuro-Ophthalmic Implications of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Related Infection and Vaccination. Asia Pac J Ophthalmol (Phila) 2022; 11:196-207. [PMID: 35533338 DOI: 10.1097/apo.0000000000000519] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
ABSTRACT The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic created a unique opportunity to study the effects of infection and vaccination on disease. The year 2020 was dominated by infection and its consequences. The year 2021 was dominated by vaccination and its consequences. It will still take several years for full maturation of databases required for robust epidemiological studies. Therefore, this review on the implications for neuro-ophthalmology draws on resources presently available including reported adverse reactions to vaccination. Illustrative clinical cases are presented.The spectrum of pathology following infection with SARS-CoV-2 falls into 4 main categories: autoimmune, vascular, sequelae of brain damage, and miscellaneous. This review is exhaustive, but the most common conditions discussed relate to headaches and associated symptoms; vertigo, diplopia, and nystagmus; vascular complications of the eye and brain; cranial nerve (mono-)neuropathies; photophobia, ocular discomfort, and optic neuritis. Of the 36 main adverse reactions reviewed, vaccine-induced immune thrombotic thrombocytopenia is a novel complication requiring specific hematological management. Updated diagnostic criteria are summarized. It is relevant to remember taking a medication history because of side effects and to recognize the relevance of comorbidities. The clinical assessment can frequently be performed virtually. Consensus recommendations on telemedicine and the virtual assessment are summarized in a practical and compressed format.The review concludes with an epidemiological tetralogy to interrogate, in future studies, associations with (1) SARS-CoV-2 pandemic infection, (2) SARS-CoV-2 worldwide vaccination, and (3) the possibility of a rebound effect of infections in the pandemic aftermath.
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Affiliation(s)
- Axel Petzold
- Department of Neurodegeneration, UCL Queen Square Institute of Neurology, Department of Neurology, The National Hospital for Neurology and Neurosurgery; Moorfields Eye Hospital, London, United Kingdom
- Amsterdam UMC, Neuro-ophthalmology Expertise Centre, NL, US
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30
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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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Zhang W, Bi DG, Peng XY, Gu W. Peripapillary hyper-reflective ovoid mass-like structure and dome-shaped maculopathy: A case report. Medicine (Baltimore) 2022; 101:e28652. [PMID: 35060557 PMCID: PMC8772646 DOI: 10.1097/md.0000000000028652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/04/2022] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Peripapillary hyperreflective ovoid mass-like structures (PHOMS) and dome-shaped macula (DSM) are 2 optical coherence tomography findings reported in 2018 and 2008, respectively. To date, there have been no ophthalmic case reports of concomitant PHOMS and DSM. PATIENT CONCERNS A 19-year-old woman presented to our clinic with complaints of decreased vision in both eyes. DIAGNOSIS The patient was diagnosed with PHOMS and a dome-shaped macula complicated by subretinal fluid in both eyes. INTERVENTIONS A micropulse laser under the guidance of Indocyanine green angiography was applied to the hyperfluorescent areas and drugs to improve retinal microcirculation. OUTCOMES No response to any intervention over the 41 months of follow-up, her visual acuity remained the same, and the subretinal fluid often recurred. LESSONS PHOMS and DSM are associated with myopia; myopia may be a mediator between PHOMS and DSM. Dome-like structural changes may occur in different parts of the retina (optic disc and macula), caused by asymmetric myopic posterior scleral growth.
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Affiliation(s)
- Wei Zhang
- Department of the Ophthalmology, Beijing Aier Intech Eye Hospital, Beijing, China
- Department of the Ophthalmology, Beijing Tongren Eye Hospital, Capital Medical University, Beijing, China
| | - Da-Guang Bi
- Department of the Ophthalmology, Beijing Aier Intech Eye Hospital, Beijing, China
| | - Xiao-Yan Peng
- Department of the Ophthalmology, Beijing Tongren Eye Hospital, Capital Medical University, Beijing, China
| | - Wei Gu
- Department of the Ophthalmology, Beijing Aier Intech Eye Hospital, Beijing, China
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Jothi Balaji J, Lakshminarayanan V. ODTiD: Optic Nerve Head SD-OCT Image Dataset. Clin Ophthalmol 2021; 15:4239-4245. [PMID: 34707343 PMCID: PMC8544271 DOI: 10.2147/opth.s337174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/11/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Optic disc tilt (ODT) or tilted optic disc is a common finding in the general population. It is due to anomalous development caused by the malclosure of the embryonic optic fissure. ODT is commonly associated with high myopia as well as other conditions. In recent days, the common method to image the optic disc (OD) is by optical coherence tomography (OCT). To the best of our knowledge, there are no datasets of ODT available in the public domain. This dataset aims to make open access raw ODT OCT images to test out new image processing segmentation algorithms. Methods This dataset of ODT images contains both horizontal and vertical cross-sectional images obtained using spectral-domain optical coherence tomography (SD-OCT, Cirrus 5000, Carl Zeiss Meditec Inc., Dublin, CA). The optic disc cube 200×200 program was used and all the images are aligned with the center of the optic nerve head. This dataset includes images from both clinically normal (20 eyes) and myopic subjects (101 eyes). Results The dataset consists of clear (121) and manually marked (121) images resulting in a total of 242 images. The age distribution for all subjects combined is 27.24 ± 9.28 (range, 11.0-69.0) years. For normal subjects mean ± SD age distribution is 32.40 ± 17.23 years. Similarly, the myopia age distribution is 26.22 ± 6.37 years. Ground truth images, ie, manually segmented by a clinical expert are provided along with other meta-data includes age, gender, laterality, refractive error classification, spherical equivalent (SE), best-corrected visual acuity (BCVA), intraocular pressure (IOP), and axial length (AXL). Conclusion This open, public database is online at the ICPSR website of the University of Michigan. The dataset can be used to test and validate newly developed automated segmentation algorithms.
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Affiliation(s)
| | - Vasudevan Lakshminarayanan
- Theoretical and Experimental Epistemology Lab, School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, N2L 3G1, Canada
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Wicklein R, Wauschkuhn J, Giglhuber K, Kümpfel T, Hemmer B, Havla J, Knier B. Association of peripapillary hyper-reflective ovoid masslike structures and disease duration in primary progressive multiple sclerosis. Eur J Neurol 2021; 28. [PMID: 34374178 DOI: 10.1111/ene.15056] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/15/2021] [Accepted: 08/05/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Peripapillary hyper-reflective ovoid masslike structures (PHOMS) are a novel finding during retinal optical coherence tomography in patients with multiple sclerosis (MS). To date, there are no data on the occurrence of PHOMS in early MS. The aim of this study was to investigate the frequency of PHOMS in patients with first diagnosed early relapsing-remitting MS (RRMS) and to search for associations of PHOMS with disease patterns in different MS subtypes. METHODS This was a cross-sectional analysis in two different cohorts: cohort 1, consisting of early RRMS patients (n = 349); cohort 2, consisting of patients with primary progressive MS (PPMS) (n = 66) and RRMS (n = 65). RESULTS Peripapillary hyper-reflective ovoid masslike structures were detected in 18.3% of patients with early RRMS. The occurrence of PHOMS was not associated with age, disease duration and disability. Investigating clinical patterns and the occurrence of PHOMS (cohort 2), an association of PHOMS with higher Expanded Disability Status Scale measures (PHOMS 4.9, 3.7-6.1; no PHOMS 3.5, 3.0-5.3; p = 0.03) and longer disease durations (PHOMS 6.5 years, 1.9-11.0; no PHOMS 1.0 years, 0.0-4.0, p = 0.0007) was found in patients with PPMS but not RRMS. After p value adjustment, the disease duration appeared to be more relevant (β = 0.16, p = 0.06). CONCLUSION Peripapillary hyper-reflective ovoid masslike structures were found in 18% of patients with early MS. The presence of PHOMS might be associated with disease progression only in PPMS but not RRMS, suggesting that PHOMS might be embedded in neurodegenerative processes.
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Affiliation(s)
- Rebecca Wicklein
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Data Integration for Future Medicine (DIFUTURE) Consortium, Munich, Germany
| | - Josephine Wauschkuhn
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Katrin Giglhuber
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Tania Kümpfel
- Data Integration for Future Medicine (DIFUTURE) Consortium, Munich, Germany.,Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians Universität München, Munich, Germany
| | - Bernhard Hemmer
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Data Integration for Future Medicine (DIFUTURE) Consortium, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Joachim Havla
- Data Integration for Future Medicine (DIFUTURE) Consortium, Munich, Germany.,Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians Universität München, Munich, Germany
| | - Benjamin Knier
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Data Integration for Future Medicine (DIFUTURE) Consortium, Munich, Germany
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OCT Based Interpretation of the Optic Nerve Head Anatomy and Prevalence of Optic Disc Drusen in Patients with Idiopathic Intracranial Hypertension (IIH). Life (Basel) 2021; 11:life11060584. [PMID: 34205357 PMCID: PMC8234108 DOI: 10.3390/life11060584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/07/2021] [Accepted: 06/17/2021] [Indexed: 12/19/2022] Open
Abstract
We aimed to systematically examine the optic nerve head anatomy in patients with idiopathic intracranial hypertension (IIH) using a standardized optical coherence tomography (OCT) protocol. The study retrospectively included 32 patients diagnosed from 2014 to 2021 with IIH. Using OCT, in accordance with a standardized scanning protocol for patients with optic disc drusen, the presence of optic disc drusen, prelaminar hyperreflective lines, peripapillary hyperreflective ovoid mass-like structures, the retinal nerve fiber layer thickness, and macular ganglion cell layer volume was obtained. Optic disc drusen were found in 3.1%, hyperreflective lines in 31.3%, and peripapillary hyperreflective ovoid mass-like structures in 81.3% of all IIH patients at least three months after the time of diagnosis. We found no significant differences in retinal nerve fiber layer thickness or macular ganglion cell layer volume in patients with hyperreflective lines or PHOMS respectively compared to patients without hyperreflective lines (p = 0.1285 and p = 0.1835). In conclusion, the prevalence of optic disc drusen in IIH patients is similar to the reported prevalence in the general population. The high prevalence of hyperreflective lines and peripapillary hyperreflective ovoid mass-like structures in IIH patients suggest these structures be a result of crowding in the optic nerve head caused by papilledema.
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