![]() ![]() The circumferential extent and characteristic 3D toroidal nature of a PHOMS are best appreciated by scrolling through consecutive OCT images.Ĭopyright © 2021 by North American Neuro-Ophthalmology Society. They do not exclude papilledema and often accompany it. They are not themselves ODD or ODD precursors, although they can be seen in association with ODD and a wide spectrum of other conditions. PHOMS are a common but nonspecific OCT marker of axoplasmic stasis in the optic nerve head. Because of the radial symmetry of these herniating optic nerve fibers, PHOMS are best thought of as a complete or partial torus (i.e., donut) in 3 dimensions. The histopathological study of these diverse entities reveals the common feature of a bulge of optic nerve fibers herniating centrifugally over Bruch membrane opening into the peripapillary space, correlating exactly with the location, shape, and space-occupying nature of PHOMS on OCT. ![]() PHOMS are seen in many conditions, including papilledema, nonarteritic anterior ischemic optic neuropathy, central retinal vein occlusion, acute demyelinating optic neuritis, ODD, and tilted disks (myopic obliquely inserted disks) and in many cases resolve along with the underlying condition. PHOMS can be broadly classified as disk edema-associated PHOMS, ODD-associated PHOMS, or anomalous disk-associated PHOMS. The histopathological underpinnings of PHOMS are now becoming more clearly understood. ![]() Although originally assumed to represent a form of buried optic disc drusen (ODD), PHOMS differ from ODD in many important ways. With the development and widespread adoption of spectral-domain optical coherence tomography (OCT), peripapillary hyper-reflective ovoid mass-like structures (PHOMS) have become a frequent OCT finding in neuro-ophthalmic practice. ![]()
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