Is the presence of peripapillary hyperreflective ovoid formations (PHOM) in children associated with optic disc area, scleral canal diameter and refractive status?

Target

Recently, peripapillary hyperreflective ovoid mass-like structures (PHOMS) have been described on optical coherence tomography (OCT) images of the optic nerve. We aim to determine whether there is a causal relationship between OCT measurements of optic disc area (DA), scleral canal diameter (SCD), and refractive error (spherical equivalent, SE) with the presence of PHOMS.

Methods

A retrospective analysis was performed of OCT scans that were assessed for the presence or absence of PHOMS in children with suspected papilledema. Data on disk area, YES (mm²) and scleral canal diameter, SCD (µm) were obtained from the OCT scan results. Statistical analysis was performed in two subgroups: unilateral PHOMS and contralateral control; all eyes with MHIF compared to all eyes without MHIF (control). Logistic regression analysis was performed.

Results

With a unilateral compulsory medical insurance (n= 32), there was a nonsignificant trend toward increased DA and SCD in the eye with PHOMS (3.33 mm).²1701 µm) compared to the contralateral eye of the same patient (2.83 mm).²1556 µm). Broader analysis of all eyes using PHOMS (n= 116) compared to all eyes without (n= 104) showed that there was a significant difference between DA (3.38 mm² vs 2.65 mm² n= <.0001) and SCD (1763 µm vs 1571 µm, n= <.0001). Logistic regression showed that SCD makes a significant contribution to predicting the presence of PHOMS (OR 1.0042, n= 0.0017).

Conclusions

PHOMS are often observed in pseudopapilloma. It would be beneficial to understand their pathophysiology, as accurate diagnosis in the context of an asymptomatic pediatric population is critical. We report that wider scleral canal diameter was significantly associated with the presence of PHOMS.