Peripapillary Hyperreflective Ovoid Mass-Like Structures in a Patient with Nonarteritic Anterior Ischemic Optic Neuropathy

A 78-year-old woman presented with an upper visual field defect in the left eye. Her best-corrected visual acuity (BCVA) was 1.2 in both eyes. Fundoscopy revealed inferior optic disc swelling. Peripapillary optical coherence tomography (OCT) demonstrated the presence of peripapillary hyperreflective ovoid mass–like structures (PHOMS) that was located in the inferior portion of the left eye. The patient was diagnosed with nonarteritic anterior ischemic optic neuropathy (NAION) of the left eye. One month after the initial visit, her BCVA decreased to 0.15 in the left eye. Fundoscopy revealed superior optic disc swelling. OCT demonstrated the presence of PHOMS that was located in the superior portion of the left eye. She was diagnosed with recurrent NAION. Three months later, her BCVA was maintained at 0.2, however, the optic disc looked diffusely pale. This case highlights the importance for clinicians to be aware of PHOMS with NAION.