Photo Credit: BSIP SA
The following is a summary of “Are PHOMS (Peri papillary hyperreflective ovoid mass-like structures) with an elevated optic disc still a diagnosis dilemma?” published in the September 2024 issue of Ophthalmology by Maalej et al.
Researchers conducted a retrospective study identifying clinical features that can help confirm or exclude the diagnosis of idiopathic intracranial hypertension (IIH) in patients referred for papilledema (PE) with peripapillary hyperreflective ovoid mass-like structures (PHOMS).
They included all patients referred for PE, excluding those with Frisén grade ≥3, optic neuritis, or other specific optic neuropathies. Patients were split into 2 groups: isolated PHOMS and PHOMS associated with IIH. The PHOMS location was analyzed using OCT-EDI, and their volume was calculated, focusing on pRNFL, GCC, and PHOMS volume.
The results showed that 154 patients (308 eyes) were studied, with an average age of 29 and 78% female. PHOMS were linked to various causes: IIH (38.3%), isolated PHOMS (35.7%), posterior uveitis (11%), optic disc drusen (ODD, 10%), and tilted optic disc (5%). An MRI was done in 83.1% of cases, with over half suggesting IIH, but only 39.7% had confirmed IIH with 44.5% of sensitivity and 55.5% of sensibility. PHOMS were primarily found in the nasal region (95.5%). The location of PHOMS in the superior and inferior quadrant was significantly associated with IIH or ODD, while presence in the temporal or nasal sector was associated with isolated lesions. The PHOMS mean, and median volume were 1.66 μm3 and 1.50 μm3, respectively, significantly more prominent in patients with IIH (P=0.0037). Visual function showed no significant changes, while mean pRNFL decreased by -4.225 μm at 3 months and -6.489 μm at 6 months, compared to the initial measurement.
Investigators concluded that isolated PHOMS should be recognized as a separate condition. In asymptomatic patients, careful observation of nasal or temporal location, small volume, and stability over time can help alleviate anxiety and reduce potential morbidity.
Source: aaojournal.org/article/S0161-6420(24)00555-4/abstract
