Peripapillary Ovoid Hyperreflectivity in Optic Disc Edema and Pseudopapilledema

Malmqvist, Lasse; Sibony, Patrick A.; Fraser, Clare L.; Wegener, Marianne; Heegaard, Steffen; Skougaard, Marie; Hamann, Steffen

doi:10.1016/j.ophtha.2018.04.036

Cited by 36 publications

(58 citation statements)

References 4 publications

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“…b), can contribute to a prelaminar crowding phenomenon; axons are compressed and subsequently swell, and nerve tissue is displaced causing the presence of localized peripapillary axonal distension (LPAD) – on optical coherence tomography (OCT) seen as peripapillary hyperreflective ovoid mass‐like structures (PHOMS) (Malmqvist et al. a,c).…”

Section: Introductionmentioning

confidence: 99%

Prevalence and histopathological signatures of optic disc drusen based on microscopy of 1713 enucleated eyes

Skougaard

Heegaard

Malmqvist

et al. 2019

Acta Ophthalmologica

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Purpose Optic disc drusen (ODD) are calcified optic nerve head deposits. Objectives of this study were to examine the prevalence of ODD in eyes removed by enucleation and to describe related histopathological signatures of ODD and surrounding tissues. Methods The study was a retrospective observational case series study assessing and re‐evaluating enucleated eyes in Denmark from 1980 to 2015 by microscopy. Individual ODD were described based on size, number and location (superficial and/or deep) within the optic nerve. Optic nerve heads with ODD were assessed for elevated discs, retinal nerve fibre layer (RNFL) thickness, oedematous axons and presence of localized peripapillary axonal distension (LPAD) equivalent to the peripapillary hyperreflective ovoid mass‐like structures seen on optical coherence tomography. Results Microscopy of 1713 eyes revealed ODD in 31 eyes equivalent to a prevalence of 1.8%. Optic disc drusen (ODD) were seen as circular shapes of different sizes and varying number. Elevated discs were present in 15 (54%) of the cases. Thickening of the superficial RNFL was present in eyes with large deeply located ODD. For more superficial ODD of approximately same size, the RNFL was thinner. Oedematous axons were present in three eyes. Localized peripapillary axonal distension (LPAD) was seen in five eyes. Conclusions Prevalence of ODD in this study of histopathological signatures was higher than the prevalence found in clinical studies. Our results suggest that large, deep ODD might cause crowding and herniation of axons in the optic nerve head leading to a thickened superficial nerve fibre layer, pseudopapilledema and LPAD.

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Section: Introductionmentioning

confidence: 99%

Prevalence and histopathological signatures of optic disc drusen based on microscopy of 1713 enucleated eyes

Skougaard

Heegaard

Malmqvist

et al. 2019

Acta Ophthalmologica

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“…In addition to ODD, PHOMS have also been associated with optic disc oedema from a variety of other causes including: papilloedema, NA-AION, central retinal vein occlusion, papillitis, and tilted or myopic obliquely inserted discs. 16 In fact, the first report describing PHOMS was published by Pichi et al in 2014, in paediatric cases of tilted optic disc syndrome. 17 Recently, PHOMS were investigated using OCT angiography (OCTA) in two cases of tilted disc syndrome, and one case of ODD.…”

Section: Peripapillary Hyper-reflective Ovoid Mass-like Structures (Pmentioning

confidence: 99%

Diagnosing Optic Disc Drusen in the Modern Imaging Era: A Practical Approach

Costello

Rothenbuehler

et al. 2020

Neuro-Ophthalmology

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Optic disc drusen (ODD) are a well-recognised cause of an elevated optic disc appearance. When visible with ophthalmoscopy and fundus photography, ODD are readily identified. Yet, in more subtle cases of ODD, ancillary testing may be needed to render the diagnosis. Facilitating the diagnosis of ODD has clinical relevance, because affected individuals may otherwise undergo unnecessary costly and invasive investigations to rule out raised intracranial pressure and other causes of optic disc oedema. In this review, the role of established and emerging optical coherence tomography (OCT) techniques in the diagnosis and management of ODD cases is reviewed. A practical approach is taken to explain how to optimise use of commercially available OCT technology in the clinical setting. Optical coherence tomography provides many advantages over other imaging modalities in the diagnosis of ODD, including the ability to correlate retinal measures of neuroaxonal structure with drusen characteristics. Earlier spectral domain OCT techniques, however, were hindered by poor penetrance. In the modern imaging era, enhanced depth imaging OCT and swept source OCT enable higher resolution of ODD and other optic nerve head structures that might otherwise be mistaken for drusen. Ongoing studies featuring OCT angiography indicate that this technique may provide complementary information about microvascular supply that correlate with structural measures of optic nerve injury. Advances in OCT will continue to improve diagnostic accuracy and inform clinical understanding regarding structure-function correlations germane to the longitudinal follow up of ODD patients.

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“…A few reports have described PHOMS in association with ODD on OCT B-scan. 10,13 PHOMS represent the distension of the crowded prelaminar peripapillary axons compressed by drusen. 23 The present cases demonstrated that the hypofluorescence of PHOMS coincided with the area loss of RPE cells containing intrinsic fluorophores.…”

Section: Imaging Modalities In Diagnosis Of Oddmentioning

confidence: 99%

Multimodal Imaging Features of Optic Disc Drusen

Yan

Ludwig

Liao

2021

American Journal of Ophthalmology

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To identify key en face multimodal imaging features of optic disc drusen (ODD).DESIGN: Retrospective cross-sectional study. METHODS: SETTING: a single academic center. PATIENT OR STUDY POPULATION: 786 patients (10-82 years of age) with diagnostic codes for optic disc drusen (ODD) in clinical notes extracted using natural language processing. INTERVENTION OR OBSERVATION PROCEDURES: color fundus imaging, green-light and blue-light fundus autofluorescence (FAF), near-infrared reflectance (NIR), and enhanced-depth imaging optical coherence tomography (EDI-OCT). MAIN OUTCOME MEASUREMENTS: Ophthalmic imaging characteristics and sensitivity of en face imaging compared with EDI-OCT.RESULTS: A total of 38 patients (61 eyes) had highquality EDI-OCT scans and en face multimodal imaging. Green-light FAF imaging had the highest diagnostic sensitivity (96.8%) for ODD and showed homogeneous hyperautofluorescence, whereas blue-light FAF imaging had heterogeneous brightness, which helped differentiate superficial from deep ODD. Blue-light FAF (93.5%) and NIR (91.8%) imaging were also sensitive tests and revealed papillary and peripapillary features that were not well seen on green-light FAF, including the size and depth of ODD, morphology of the optic disc, and common ODD-associated structures such as horizontal hyperreflective lines and peripapillary hyper-reflective ovoid mass-like structures (PHOMS). Color fundus imaging had the lowest sensitivity (82%). There was good interrater reliability for all en face imaging modalities (P < .0001 for all).CONCLUSIONS: In en face imaging, green-light FAF had the highest sensitivity for the diagnosis of ODD, whereas blue-light FAF and NIR images provided more information regarding the severity, location, depth, and size of ODD. In eyes that are negative on green-light FAF, EDI-OCT should be performed and provides the highest-resolution characterization of the entire optic disc to assess or rule out ODD.

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Peripapillary Ovoid Hyperreflectivity in Optic Disc Edema and Pseudopapilledema

Cited by 36 publications

References 4 publications

Prevalence and histopathological signatures of optic disc drusen based on microscopy of 1713 enucleated eyes

Prevalence and histopathological signatures of optic disc drusen based on microscopy of 1713 enucleated eyes

Diagnosing Optic Disc Drusen in the Modern Imaging Era: A Practical Approach

Multimodal Imaging Features of Optic Disc Drusen

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