Longitudinal Development of Peripapillary Hyper‐Reflective Ovoid Masslike Structures Suggests a Novel Pathological Pathway in Multiple Sclerosis

• Published in: Annals of neurology 2020-08, Vol.88 (2), p.309-319
• Main Authors: Petzold, Axel, Coric, Danko, Balk, Lisanne J., Hamann, Steffen, Uitdehaag, Bernard M. J., Denniston, Alastair K., Keane, Pearse A., Crabb, David P.
• Format: Article
• Language: English
• Subjects: Adult; Anisotropy; Atrophy; Correlation analysis; Disease control; Eye; Female; Follow-Up Studies; Humans; Hypertension; Intracranial pressure; Longitudinal Studies; Magnetic resonance imaging; Magnetic Resonance Imaging - trends; Male; Medical treatment; Middle Aged; Multiple sclerosis; Multiple Sclerosis - complications; Multiple Sclerosis - diagnostic imaging; Neuritis; Neuroimaging; Optic atrophy; Optic Disk - diagnostic imaging; Optic neuritis; Optical Coherence Tomography; Prospective Studies; Retrospective Studies; Tensors; Tomography, Optical Coherence - trends
• ISSN: 0364-5134; 1531-8249
• DOI: 10.1002/ana.25782

Objective Peripapillary hyper‐reflective ovoid masslike structures (PHOMS) are a new spectral domain optical coherence tomography (OCT) finding. Methods This prospective, longitudinal study included patients (n = 212) with multiple sclerosis (MS; n = 418 eyes), 59 healthy controls (HCs; n = 117 eyes), and 267 non‐MS disease controls (534 eyes). OCT and diffusion tensor imaging were used. Results There were no PHOMS in HC eyes (0/117, 0%). The prevalence of PHOMS was significantly higher in patients with MS (34/212, p = 0.001) and MS eyes (45/418, p = 0.0002) when compared to HCs (0/59, 0/117). The inter‐rater agreement for PHOMS was 97.9% (kappa = 0.951). PHOMS were present in 16% of patients with relapsing–remitting, 16% of patients with progressive, and 12% of patients with secondary progressive disease course (2% of eyes). There was no relationship of PHOMS with age, disease duration, disease course, disability, or disease‐modifying treatments. The fractional anisotropy of the optic radiations was lower in patients without PHOMS (0.814) when compared to patients with PHOMS (0.845, p = 0.03). The majority of PHOMS remained stable, but increase in size and de novo development of PHOMS were also observed. In non‐MS disease controls, PHOMS were observed in intracranial hypertension (62%), optic disc drusen (47%), anomalous optic discs (44%), isolated optic neuritis (19%), and optic atrophy (12%). Interpretation These data suggest that PHOMS are a novel finding in MS pathology. Future research is needed to determine whether development of PHOMS in MS is due to intermittently raised intracranial pressure or an otherwise impaired “glymphatic” outflow from eye to brain. ANN NEUROL 2020;88:309–319.