Peripapillary hyperreflective ovoid mass-like structures: Multimodal imaging-A review.

Area of Science:

• Ophthalmology
• Neuro-ophthalmology
• Medical Imaging

Background:

• Peripapillary hyperreflective ovoid mass-like structures (PHOMS) are characterized as herniations of distended axons.
• Previously, PHOMS were often misidentified as buried optic disc drusen (ODD).
• Advancements in enhanced depth imaging-optical coherence tomography (EDI-OCT) have improved visualization of the optic nerve head (ONH).

Purpose of the Study:

• To differentiate PHOMS from other optic nerve pathologies.
• To review the association of PHOMS with various neuro-ophthalmic conditions.
• To identify knowledge gaps regarding PHOMS classification and prognosis.

Main Methods:

• Review of current literature on PHOMS.
• Analysis of imaging modalities for differential diagnosis.
• Exploration of the relationship between PHOMS and optic nerve diseases.

Main Results:

• PHOMS are distinct from buried ODD and associated with a wide range of optic nerve pathologies.
• Frequent coexistence of PHOMS with ODD, papilledema, and anterior ischemic optic neuropathy observed.
• Pathophysiology insights gained from association with conditions causing axoplasmic stasis.

Conclusions:

• PHOMS represent a significant finding beyond buried ODD.
• Understanding PHOMS' associations is crucial for neuro-ophthalmic diagnosis.
• Further research is needed for PHOMS classification and prognosis.