Features of peripapillary hyperreflective ovoid mass‐like structures (PHOMS) according to their etiology

Purpose To compare clinical and multimodal imaging findings in patients with PHOMS and correlate them with the etiology. Methods A prospective descriptive comparative study carried out at the Ophthalmology Department of Habib Thameur University Hospital of Tunis between March 1st 2020 and March 30th 2021. Inclusion criteria were presence of blurred optic disc margins. Patients with optic disc drusen were excluded. All patients underwent complete ophthalmic examination, 24.2 Humphrey visual field (VF), fluorescein angiography (FA) and Swept‐Source Optical Coherence Tomography (SS‐OCT). Comparative Mann Whitney and chi‐squared tests were performed. Results Sixteen eyes of 8 patients were eligible for the study. Mean age was 41.63 years +/‐ 10.49 years. Mean Best Corrected Visual Acuity was 0.23+‐0.27 log MAR. Main etiologies were sequelae of idiopathic intracranial hypertension (IIH) in 8 eyes (50%) and tilted disc syndrome (TDS) in 6 eyes (37.5%). VF defects were found in 12 eyes (75%). They included non‐specific scotomas (35.7%), blind spot enlargement (21.4%) and peripheral arcuate defect (12.5%). Peripapillary Retinal Nerve Fiber Layer (pRNFL) were thickened in 62.5% of eyes, altered in 31.3% and preserved in 6.3%. Inferior and nasal pRNFL showed no alterations in all eyes. SS‐OCT revealed hyperreflective lesions in all eyes, associated to posterior shadowing in 12 eyes (75%), hyperreflective dots in 10 eyes (62.5%) and peripapillary pigment epithelium detachment in 9 eyes (56.3%). There were no statistically significant differences in VF alterations between TDS and IIH group. Patients with IIH presented thicker pRNFL (p = 0.023) and were more likely to present annular leakage in FA (p = 0.012). Conclusions PHOMS is a recently described entity that can be related to several etiologies such as IIH, TDS or ischemic optic nerve neuropathy. Both TDS and IIH can lead to visual field defects. IIH is more likely to give annular retention in FA and thickening of pRNFL.