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. 2025 May;132(5):590-597.
doi: 10.1016/j.ophtha.2024.12.013. Epub 2024 Dec 14.

Characterization of Peripapillary Hyperreflective Ovoid Mass-like Structures in a Broad Spectrum of Neurologic Disorders

Jonathan A Gernert  1 , Tara Christmann  1 , Elisabeth Kaufmann  2 , Luisa Delazer  2 , Isabel Kirsch  2 , Johannes Levin  3 , Sonja Schönecker  4 , Urban M Fietzek  5 , Peter Zu Eulenburg  6 , Theresa Velten  4 , Marina Gripshi  4 , Klaus G Parhofer  7 , Esther M Maier  8 , Tania Kümpfel  1 , Amelie S Lotz-Havla  8 , Joachim Havla  9
Affiliations
Free article

Characterization of Peripapillary Hyperreflective Ovoid Mass-like Structures in a Broad Spectrum of Neurologic Disorders

Jonathan A Gernert et al. Ophthalmology. 2025 May.
Free article

Abstract

Purpose: Peripapillary hyperreflective ovoid mass-like structures (PHOMSs) have been identified in ophthalmic and neurologic diseases. Because PHOMSs were found more frequently in these cohorts compared with healthy control participants, it is assumed that the presence of PHOMSs reflects a secondary disease marker of unknown significance. The extent to which disease-specific differences are reflected in PHOMSs has not yet been investigated sufficiently.

Design: Monocentric, retrospective study.

Participants: We analyzed a large cohort of people with a broad spectrum of neurologic disorders, including neuroimmunologic diseases (NIDs; n = 237), epilepsy (n = 153), movement disorders (MDs; n = 44), intracranial hypertension (IH; n = 13), and inborn errors of metabolism (n = 90).

Methods: We analyzed the prevalence, location, volume, and intensity of PHOMSs. Peripapillary hyperreflective ovoid mass-like structure volumes were correlated with demographic and other OCT parameters.

Main outcome measures: Prevalence, location, volume, and intensity of PHOMSs.

Results: We identified PHOMSs in 7% of the analyzed eyes. Peripapillary hyperreflective ovoid mass-like structures were detected in all cohorts, and their location was predominantly nasal. The median volume of all PHOMSs was 0.06 mm3. However, the median PHOMS volume was increased in those with IH compared with those with NID (P = 0.009), epilepsy (P = 0.038), or MDs (P = 0.027). The PHOMS volume correlated positively with the opening of the Bruch membrane and correlated negatively with the age of the cohort after the exclusion of patients with IH. Overall, PHOMS intensity was comparable with that of the optic nerve.

Conclusions: Because 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 neurologic disorders with PHOMSs. Because PHOMSs have a relevant influence on OCT parameters, their presence also should be considered in nonophthalmic scientific studies in the future.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Keywords: Neurologic disorders; OCT; PHOMS.

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