Multimodal Imaging of Peripapillary Hyperreflective Ovoid Mass-Like Structures (PHOMS): Report of Two Cases

Peripapillary hyperreflective ovoid mass-like structures (PHOMS) are a novel, incompletely understood finding in several optic nerve disorders. We describe PHOMS in two Japanese men. Both underwent general ophthalmologic examination as well as multimodal imaging, including visual field testing, fundus photography, spectral-domain optical coherence tomography (SD-OCT), OCT angiography (OCTA), B-scan ultrasonography, fundus autofluorescence (FAF) imaging, and fluorescence angiography. Case 1 was a 31-year-old man with normal pupillary reactions and normal visual acuity in both eyes. SD-OCT revealed PHOMS-oval hyperintense lesions-around the right optic disc. OCTA showed a vascular complex in the PHOMS, and FAF showed a blurry area of hypoautofluorescence at the optic disc. Case 2 was a 61-year-old man who, after undergoing several examinations, was diagnosed as having primary open angle glaucoma with a tilted disc. During a comprehensive examination, a color change was detected at the nasal side of the optic disc in his left eye; SD-OCT revealed PHOMS. One of these two Japanese patients with PHOMS had no other ophthalmic conditions, while the other had glaucoma with a tilted optic disc. Although SD-OCT and OCTA were essential in diagnosing PHOMS, multimodal imaging is required in order to rule out other disorders.