Interocular Asymmetry of Peripapillary Hyperreflective Ovoid Mass-like Structures in Intrapapillary Hemorrhage with Adjacent Peripapillary Subretinal Hemorrhage

Purpose: To characterize peripapillary hyperreflective ovoid mass-like structures (PHOMS) in affected and fellow eyes of patients with intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage (IHAPSH), and to assess whether PHOMS height is associated with IHAPSH involvement. Methods: This retrospective observational study included 14 IHAPSH patients who underwent optic nerve head optical coherence tomography (OCT). PHOMS presence, distribution, and height were characterized in affected and fellow eyes. Interocular differences in PHOMS height, spherical equivalent (SE), and optic disc tilt were compared. The association between PHOMS height and IHAPSH involvement was then analyzed using a linear mixed-effects model (LMM), adjusting for SE and optic disc tilt. Results: All 14 IHAPSH patients had unilateral involvement. PHOMS were detected in all affected eyes and 78.6% (11/14) of fellow eyes. PHOMS were nasally located, with occasional superior or inferior extension. PHOMS height was greater in affected eyes (546.37 ± 98.33 µm) than in fellow eyes (357.12 ± 224.12 µm; P = 0.002). Affected eyes showed more myopic SE (−3.87 ± 1.57 D vs. −3.13 ± 1.76 D; P = 0.007), with no difference in optic disc tilt ( P = 0.457). In the LMM, PHOMS height was independently associated with IHAPSH involvement, with affected eyes showing 159.07 µm greater height than fellow eyes (β = 159.07 µm; P = 0.011) after adjustment for SE and optic disc tilt. Conclusion: PHOMS height was greater in affected than in fellow eyes and independently associated with IHAPSH involvement, suggesting that increased PHOMS height may reflect structural susceptibility to IHAPSH.