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Peripapillary Hyper-Reflective Ovoid Mass-like Structures in Stickler syndrome.

  • Khatib, Tasneem Z
  • Safi, Antoine
  • Nixon, TRW
  • Georgoulas, Stylianos
  • Montesano, Giovanni
  • Martin, Howard
  • Richards, Allan J
  • McNinch, Annie
  • Poulson, Arabella V
  • Alexander, Philip
  • Snead, Martin P
Publication Date
May 13, 2024
Apollo - University of Cambridge Repository
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PURPOSE: To report a previously undescribed finding of peripapillary hyper reflective ovoid mass-like structures (PHOMS) in Stickler Syndrome DESIGN: Non-comparative case series SUBJECTS: Participants, and/or Controls: 22 eyes with anomalous optic disc from 11 Stickler Syndrome patients were identified and imaged. METHODS: Intervention, or Testing: PHOMS were graded using enhanced depth imaging optical coherence tomography (EDI-OCT) according to the consensus recommendations of The Optic Disc Drusen Studies Consortium. All EDI-OCT scans were obtained using the Heidelberg Spectralis (Heidelberg Engineering, Heidelberg, Germany) with a dense horizontal raster (15 × 10°, 97 sections) centred on the optic nerve head and graded by two independent assessors. In case of disagreement, the image was graded by a third assessor. The presence of any co-existing optic disc drusen was also assessed using EDI-OCT and autofluorescence. MAIN OUTCOME MEASURES: The presence of PHOMS, clinical characteristics and genetic mutations. RESULTS: A pilot sample of 22 eyes with phenotypic optic disc abnormalities from 11 Stickler Syndrome patients were identified and imaged. Eight patients were female and 3 were male. The mean age was 31 years (13-58 years). PHOMS were present in 91% (n=20 eyes) of imaged eyes. 70% (n=14 eyes) were type 1 Stickler Syndrome and 30% (n=6 eyes) were type 2 Stickler Syndrome. Five percent (n=1 eye) developed retinal detachment and 75% (n=15 eyes) had undergone 360o prophylactic retinopexy. 41% (n=9) of eyes with PHOMS were present in patients with co-existing hearing loss and 13.6% (n=3) had orofacial manifestation of Stickler Syndrome in the form of a cleft palate. Seventy-five percent (n=15 eyes) of patients with PHOMS reported joint laxity or symptoms of arthritis. No co-existing optic disc drusen were identified and raised intracranial pressure was also excluded after neurological investigation. CONCLUSION: These data suggest that PHOMS are a novel finding in Stickler Syndrome patients and should be considered when evaluating the optic nerves of these patients.

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