Characterization of peripapillary hyperreflective ovoid mass-like structures (PHOMS) in a broad spectrum of neurological disorders

Gernert, Jonathan A. ; Christmann, Tara; Kaufmann, Elisabeth ; Delazer, Luisa ; Kirsch, Isabel; Levin, Johannes ; Schönecker, Sonja ; Fietzek, Urban M.; Eulenburg, Peter zu; Velten, Theresa; Gripshi, Marina; Parhofer, Klaus G. ; Maier, Esther M. ; Kümpfel, Tania ; Lotz-Havla, Amelie S. und Havla, Joachim (2024): Characterization of peripapillary hyperreflective ovoid mass-like structures (PHOMS) in a broad spectrum of neurological disorders. In: Ophthalmology [Forthcoming]

Abstract

Objective

Peripapillary hyperreflective ovoid mass-like structures (PHOMS) have been identified in ophthalmological and neurological diseases. Since PHOMS were found more frequently in these cohorts compared to healthy controls, it is assumed that the presence of PHOMS reflects a secondary disease marker of unknown significance. The extent to which disease-specific differences are reflected in PHOMS has not yet been sufficiently investigated.

Design

Monocentric, retrospective study.

Subjects

We analyzed a large cohort of persons with a broad spectrum of neurological disorders, including neuroimmunological diseases (NI, N=237), epilepsy (EPI, N=153), movement disorders (MD, N=44), intracranial hypertension (IH, N=13), and inborn errors of metabolism (IEM, N=90).

Methods

We analyzed the prevalence, location, volume, and intensity of PHOMS. PHOMS volumes were correlated with demographic and other optical coherence tomography (OCT) parameters. Main Outcome Measures Prevalence, location, volume, and intensity of PHOMS.

Results

We identified PHOMS in 7% of the analyzed eyes. PHOMS were detected in all cohorts, and their location was predominantly nasal. The median volume of all PHOMS was 0.06mm3. However, it was significantly increased in persons with IH compared to NI (p=0.009), EPI (p=0.038) and MD (p=0.027). The PHOMS volume correlated positively with the opening of the Bruch membrane and negatively with the age of the cohort after the exclusion of IH patients. Overall, PHOMS intensity was comparable to that of the optic nerve.

Conclusion

Since larger PHOMS volumes were found in individuals with IH, a mechanistic link to increased intracranial pressure can be assumed. It remains unclear whether this explanation also applies to individuals with other neurological disorders with PHOMS. Since PHOMS have a relevant influence on OCT parameters, their presence should also be considered in non-ophthalmologic scientific studies in the future.

• Item Type: Journal article
• Faculties: Medicine > Munich Cluster for Systems Neurology (SyNergy); Medicine > Institute for Diagnostic and Interventional Neuroradiology; Medicine > Medical Center of the University of Munich > Medical Clinic and Outpatient Clinic IV (Endocrinology, nephrology, other sections); Medicine > Medical Center of the University of Munich > Pediatric Clinic and Outpatient Clinic in the Dr. von Hauner Children‘s Hospital; Medicine > Medical Center of the University of Munich > Neurological Clinic and Polyclinic with Friedrich Baur Institute
• Subjects: 600 Technology > 610 Medicine and health
• ISSN: 01616420
• Language: English
• DFG: Gefördert durch die Deutsche Forschungsgemeinschaft (DFG) - 390857198