Evaluation of morning glory syndrome with spectral optical coherence tomography and echography

Congenital Optic Disc Anomalies: Insights from Multimodal Imaging

In this comprehensive review, we delve into the significance of multimodal imaging in diagnosing and managing complications of congenital optic disc anomalies. While the fundus examination is the gold standard tool in the diagnosis of these pathologies, spectral domain (SD) optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) could shed light on the pathogenesis and treatment. Moreover, this review seeks to offer a comprehensive insight into the multimodal approach of these rare congenital pathologies. In conclusion, congenital anomalies of the optic nerve represent a major challenge for ophthalmologists. Further research could be useful to clarify the pathophysiology of these diseases and define a correct and more specific treatment approach.

EVALUATION OF MORNING GLORY SYNDROME BY SWEPT SOURCE OPTICAL COHERENCE TOMOGRAPHY

PURPOSE

The purpose of this study was to investigate the deep structural abnormalities in the patients with morning glory syndrome by using swept source optical coherence tomography.

METHODS

The papillary and peripapillary areas of the four eyes (four patients) with morning glory syndrome were examined with a prototype swept source optical coherence tomography system with a center wavelength of 1,050 nm. In particular, the abnormalities of the lamina cribrosa and peripapillary sclera were evaluated.

RESULTS

The lamina cribrosa was posteriorly displaced in all the four eyes, and the disk area was filled with herniated retinal tissue. A bump-like protrusion near the papillary margin or within the cup area was observed in three eyes. Some tissues were observed to exist between the retina and the sclera surrounding the papillary margin annularly. In one case, swept source optical coherence tomography detected intrascleral adipose tissue in a relatively wide area around the fovea and the optic nerve.

CONCLUSION

Swept source optical coherence tomography clearly delineated the papillary and peripapillary abnormalities of morning glory syndrome. Scleral structural abnormalities were present outside the optic nerve as well.

Morphology of Serous Retinal Detachment in Morning Glory Optic Disc Anomaly in a Patient before and after Treatment with Systemic Carboanhydrase Inhibitors

BACKGROUND

Morning glory optic disc anomaly (MGODA) is a rare congenital defect of the optic nerve head. The optic nerve is enlarged, and its conical excavation is filled with glial tissue. It may be associated with cerebral malformations and ocular complications, whereas serous retinal detachment occurs in 38% of affected patients. Surgical treatment of detachment showed poor visual outcome in the past and conservative treatment options are scarce.

CASE

A woman with MGODA presented in our clinic with sudden vision loss due to serous retinal detachment. She denied any previous ophthalmological problems and her past medical history was unremarkable. Vision testing showed normal visual acuity in her left eye and finger counting in her right eye. Slit lamp examination was unremarkable. Fundus examination of the right eye showed retinal detachment without holes or traction membranes and an enlarged optic disc with raised peripapillary tissue and glial tissue in the center of the optic disc. Due to the pathognomonic otpic disc finding, we diagnosed MGODA complicated by a serous retinal detachment. We treated the patient with systemic carboanhydrase inhibitors and documented the initial clinical findings as well as the course of disease under treatment by optical coherent tomography (OCT), fundus autofluorescence imaging (FAF), and visual field testing. During follow-up, we detected noticeable subretinal fluid regression and improvement in visual acuity.

CONCLUSION

The application of oral carboanhydrase inhibitors appears to be a valid therapeutic option in patients with MGODA-associated serous macular detachment. OCT and FAF imaging are useful modalities for documentation of subretinal fluid regression and structural changes in the peripapillary region.

Case Report: Multimodal Imaging in a Rare Case of Morning Glory Disc Anomaly Complicated With Choroidal Ossification

Purpose

The authors described a 7-year-old boy who was diagnosed with morning glory disc (MGD) anomaly in the right eye via fundus examination. However, during the head CT examination, a hyperdense choroidal lesion was discovered around the optic disc. Comprehensive investigations revealed that the lesion's characteristics were extremely consistent with choroidal osteoma (CO), so the patient was diagnosed with MGD with CO on his second visit. However, in the subsequent follow-up, the author discovered pigmentary alterations in the retinal pigment epithelium (RPE) in the patient's right eye. Finally, the diagnosis was corrected to MGD with choroidal ossification following a thorough etiological analysis. Meanwhile, the characteristics of choroidal ossification were described in detail through multimodal imaging in this article.

Methods

Retrospective review of a case note.

Conclusions

Similar to CO, choroidal ossification is the consequence of structured osseous tissue formation regulated by osteoblasts and osteoclasts. It consists of bone trabecular and vascular components and is difficult to be distinguished from CO on imaging examinations. In contrast to the congenital prevalence of CO, there are often incentives for the occurrence of choroidal ossification. These inducements will eventually mediate the inflammation in the eye, resulting in the activation of many cytokines and the production of choroidal ossification. Around one-third of patients with MGD will experience retinal detachment, and in certain cases, the subretinal fluid will be absorbed spontaneously, resulting in alterations to the RPE. These processes can activate inflammatory factors in the eye, bringing about a cascade of abnormalities, including the development of CO. Therefore, the proper diagnosis of disease should not be made exclusively on the basis of the imaging findings. A thorough analysis of the epidemiology and etiology is crucial.

Management of Retinal Detachment Associated with Morning Glory Disc Syndrome

We report a case of morning glory disc anomaly in a young patient with tractional retinal detachment successfully repaired with complex pars plana vitrectomy, membrane peel, laser, and oil tamponade. A 19-year-old female with a history of right morning glory disc anomaly associated with PAX6 gene mutation presented with floaters, photopsia, central scotoma, and visual acuity (VA) of 1/200. A complex macula-involving tractional retinal detachment centered around the optic nerve with a morning glory disc anomaly. Retinal detachment was treated with 25-gauge pars plana vitrectomy with difficult separation of the posterior hyaloid. Fibrous preretinal membranes were peeled, a temporal relaxing retinotomy was required, subretinal fluid was drained through a superonasal retinotomy during air-fluid exchange, endolaser was applied, and tamponade was achieved with 1,000-centistoke silicone oil. The retina remained attached at 1-year follow-up, with VA count fingers throughout. Morning glory disc is a rare congenital anomaly associated with PAX6 gene mutation that most often occurs unilaterally. It is rarely associated with tractional retinal detachment. Optimization of visual outcome is imperative despite a poor visual prognosis.

Clinical characteristics of morning glory disc anomaly in South India

PURPOSE:

Reports of morning glory disc anomaly (MGDA) in India have mostly been case reports. The aim of this study was to describe the demographic and clinical profile of patients with MGDA in South India.

MATERIALS AND METHODS:

A retrospective review of the medical records of patients with MGDA seen at a tertiary eye hospital in South India over a period of 8 years was carried out. The patients' demographic and clinical data were extracted from the case files and were entered into Epi Info reporting software version 7.2.3.0 and then analyzed.

RESULTS:

There were 51 eyes of 44 patients with MGDA comprised 25 (56.8%) males and 19 (43.2%) females. Seven (15.9%) patients had bilateral MGDA. The mean age for females was 5.8 years (standard deviation [SD]: 5.8) and for males, 11.2 years (SD: 12.1). This difference was not statistically significant with a P = 0.07. The most common ocular associations were strabismus, refractive error, and retinal detachment, whereas the most common systemic associations were cleft lip and cleft palate. Fifty-one percent of eyes were blind at presentation.

CONCLUSION:

Patients with MGDA in India tend to present late with poor visual prognosis. Early diagnosis and prompt treatment of blinding complications are crucial in reducing the risk of irreversible visual loss. Associated systemic abnormalities highlight the importance of a multidisciplinary approach in the management of patients with this condition.

Structural and vascular features in cavitary congenital optic disc anomaly associated with metaphyseal acroscyphodysplasia

PURPOSE

To evaluate the radial peripapillary vascular plexus of a cavitary congenital optic disc anomaly in a young patient with recessive autosomal metaphyseal acroscyphodysplasia using optical coherence tomography angiography (OCTA).

METHODS

Observational case report.

RESULTS

A 17-year-old man, with diagnosis of metaphyseal acroscyphodysplasia was referred to Eye Clinic for fundus examination and multimodal imaging for retinal epithelium hypertrophy in the right eye. Clinical examination showed cup-shaped metaphyses, short stature, hyperthelorism, and telecanthus. An optic disc coloboma was detected in the right eye on fundus examination. Wide field en-face Optical Coherence Tomography (OCT) showed a hyporeflective area corresponding to the right optic disc coloboma. At OCTA examination, the whole papillary region revealed a rarefaction of the vascular network, while the ganglion cell complex's and retinal fiber layers' parameters were normal in both eyes.

CONCLUSION

The presence of coloboma disc congenital defect linked to embryological abnormalities during the development process could pave the way for a wider understanding of the pathogenesis of metaphyseal acroscyphodysplasia by increasingly framing it as a systemic disease.

Contractile morning glory disk anomaly: analysis of the cyclic contractions and literature review

PURPOSE

To investigate the contraction mechanism of morning glory disk anomaly using computer-assisted analysis of the cyclic contractions frame by frame and to review the literature on contractile morning glory disk anomaly cases.

METHODS

The fundus video of the patient under anesthesia was recorded using RetCam C300 lens. Frames at 1 second intervals were extracted to quality-preserving TIFF images and manually selected areas of cup, disk, and pigmented ring were measured with image analysis software. Measurements were repeated twice, and estimated uncertainties were calculated.

RESULTS

Two full-contraction phases and 1 half- and 1 full-dilation phase were recorded and analyzed. At the end of the second dilation phase, cup, disk, and pigmented ring were dilated to 93.7%, 97.6%, and 98.3% of their areas after first dilation. At the end of the second contraction cup, disk and pigmented ring areas remained 1.24, 1.01, and 1.01 times larger, respectively, than the areas at the end of the first contraction.

CONCLUSIONS

Ectopic cholinergic muscle contraction alone is unlikely to explain the cyclic contraction dilation movements under constant stimulus. Potentially present smooth muscle cells can be provoked by the stretch caused by the influx of fluid into the subretinal space. Change in spatial configuration and oscillations with decreasing magnitudes can be explained by decreasing contractions due to decreasing stretch with decreasing fluid influx in each cycle after the initial triggering of outside pressure, causing the greatest pressure gradient and the greatest fluid influx.

INTRAVITREAL AFLIBERCEPT IN THE TREATMENT OF POLYPOIDAL CHOROIDAL VASCULOPATHY ASSOCIATED WITH MORNING GLORY SYNDROME

PURPOSE

To describe an unusual case of polypoidal choroidal vasculopathy secondary to morning glory syndrome successfully treated with three aflibercept intravitreal injections.

METHODS

Case report.

RESULTS

A 68-year-old white man presented with a 2-month history of diminished vision of his left eye. Fundus examination showed a morning glory syndrome disk anomaly with some perimacular subretinal hemorrhages and lipid depositions. Fundus autofluorescence, fluorescein and green indocyanine angiography, spectral domain optical coherence tomography, and optical coherence tomography angiography were performed and confirmed the presence of a juxtapapillary polypoidal choroidal vasculopathy with intraretinal and subretinal fluid. Patient underwent 3 monthly intravitreal injections of aflibercept and at 4-month follow-up visit, multimodal imaging findings did not show any kind of neovascular lesion activity.

CONCLUSION

Polypoidal choroidal vasculopathy can occur in morning glory syndrome and it can be successfully treated with anti-vascular endothelial growth factor intravitreal injections of aflibercept.

An unusual association of Morning Glory Syndrome with chronic myeloid leukemia-Philadelphia chromosome

Morning glory disc anomaly (MGDA) is a rare congenital malformation that results from the incomplete formation of the optic nerve in utero. The majority of the patients have unilateral involvement and poor vision leading to sensory strabismus. Morning Glory Syndrome (MGS) may be a part of other syndromes and systemic abnormalities like transsphenoidal basal encephalocele, midfacial malformations, absent optic chiasma, MoyaMoya syndrome, and renal agenesis. In the present report, we describe a patient with a large disc with an excavated posterior scleral opening with a white glial tuft at the centre. The blood vessels were increased in number and arranged radially from the disc with peripapillary hyperpigmentation in clumps. Funnel-shaped excavation of the posterior globe was also noted on MRI. Associated ocular features were microcornea, nystagmus, esotropia, and systemic features included chronic myeloid leukemia- Philadelphia chromosome (CML-PC) and empty sella turcica. We report an unusual association of MGS with CML-PC.

Optical coherence tomography angiography in contractile morning glory syndrome

This study describes the optical coherence tomography and optical coherence tomography angiography features of three eyes of three patients affected by contractile morning glory syndrome. Optical coherence tomography angiography scans of the peripapillary retina revealed a dense microvascular network without any vascular difference between the superficial vascular plexus and the deep vascular plexus around the optic nerve. These optical coherence tomography angiography findings confirm that the contractile movement could be due to the presence of an autonomic cholinergic muscular mechanism in the posterior part of the globe. In fact in our cases, the contractile movement seemed to be induced by massage of the eyeball. Optical coherence tomography angiography is a valid, non-invasive, dyeless, and reliable method that could shed light on the pathogenesis of this rare disease of the optic disk.

Postoperative follow-up of a case of atypical morning glory syndrome associated with persistent fetal vasculature

BACKGROUND

Morning glory syndrome is a relatively rare congenital optic disc anomaly that is often difficult to identify when associated with additional congenital ocular anomalies. This case report describes the diagnosis, treatment, and postoperative follow-up care of a young girl with morning glory syndrome accompanied by persistent fetal vasculature, retinal fold, and retinal detachment. Here, we also give a brief review of the relevant literature.

CASE PRESENTATION

A 5-year-old girl was referred to our clinic for a complaint of decreased vision for 6 months in the right eye. The best corrected visual acuity was hand motion in her right eye and 0.8 in her left eye. A fundus examination indicated vitreous opacities and scattered hemorrhages, as well as striped folds in the temporal retina of the affected eye. B-ultrasound and magnetic resonance imaging scans suggested that it could be a congenital dysplasia of the right eye. Pars plana vitrectomy was performed in the right eye. Morning glory syndrome associated with persistent fetal vasculature was confirmed in subsequent follow-up observation according to the fundus appearance, optical coherence tomography, and fundus fluorescein angiography imaging.

CONCLUSIONS

The patient was diagnosed as morning glory syndrome associated with persistent fetal vasculature and retinal fold. The morning glory disc with the presence of retinal folds did not seem quite typical and that made the diagnosis difficult. This report stresses the importance of considering concurrent morning glory syndrome and persistent fetal vasculature. Vitrectomy may be beneficial in the management of the morning glory syndrome and persistent fetal vasculature if accompanied by retinal detachment in similar cases.

RETINAL DETACHMENT ASSOCIATED WITH PERIPAPILLARY STAPHYLOMA IMAGED WITH SWEPT SOURCE OPTICAL COHERENCE TOMOGRAPHY

PURPOSE

To examine a rhegmatogenous retinal detachment (RRD) associated with a peripapillary staphyloma with swept source optical coherence tomography (SS-OCT) before and after vitrectomy and circumferential photocoagulation.

METHODS

The SS-OCT images including the montage images of two patients with a RRD associated with peripapillary staphylomas were analyzed. A 34-year-old woman (Case 1) and a 70-year-old woman (Case 2) both noticed temporal visual field defects in their left eyes. Ophthalmoscopy showed a retinal detachment in the nasal quadrant without any peripheral breaks in both patients. The best-corrected visual acuity was 20/20 with -8.5 diopters in Case 1 and 20/25 with -7.0 diopters and moderate cataract in Case 2. SS-OT was used to follow the clinical course of the RRD.

RESULTS

Preoperatively, retinal tears were detected nasal to the optic disk within the excavated staphyloma in the SS-OCT images. A posterior vitreous detachment was not present in Case 1 but was present in Case 2. The glial tissue at the edge of the excavated staphyloma was removed from both eyes, and the subretinal fluid was drained internally through the retinal breaks. Hemicircumferential photocoagulation was performed at the nasal edge of the staphyloma, and the retina was reattached in both eyes. Postoperative SS-OCT montage images showed retinal reattachment but a detachment was still present within the staphyloma.

CONCLUSION

Vitreous surgery was effective for an RRD associated with a peripapillary staphyloma. Examinations by SS-OCT can follow the changes in the RRD and the excavated lesion of a peripapillary staphyloma.

RETINAL DETACHMENT AND RETROBULBAR CYSTS IN A LARGE COHORT OF OPTIC NERVE COLOBOMA

PURPOSE

To examine the relationship between retinal detachment and retrobulbar cysts in patients with optic nerve coloboma (ONC) and Morning Glory syndrome (MGS).

METHODS

Patients diagnosed with either ONC or MGS were identified through a search of the Sick Kids database. Seventy-one patients either agreed to come in for a B-scan or had an incidental orbital B-scan or magnetic resonance imaging or both. Eyes with orbital B-scan ultrasound and/or magnetic resonance imaging images were assessed independently by two ophthalmologists and a radiologist for the presence of retrobulbar cysts. Retinal detachment was identified clinically with either indirect ophthalmoscopy or from fundus photographs.

RESULTS

Forty-five of 71 (63%) and 26/71 (37%) patients had ONC and MGS, respectively. Retinal detachment occurred significantly more often in eyes with MGS than with ONC (9/17 [53%] vs. 5/45 [11%], P = 0.03, respectively). Retrobulbar cysts were not detected more often in MGS than in ONC (11/45 [24%] vs. 7/26 [27%]; P = 1.0). Eyes with retrobulbar cysts were significantly more likely to be associated with retinal detachment than those without (7/18 [39%] vs. 7/53 [13%]; P = 0.04).

CONCLUSION

Retinal detachment occurs more frequently in MGS than in ONC in a cohort of patients referred to a specialist children's retinal service. Eyes with retrobulbar cysts are more likely to be associated with retinal detachment.

Congenital anomalies of the optic disc: insights from optical coherence tomography imaging

PURPOSE OF REVIEW

Congenital anomalies of the optic nerve are rare but significant causes of visual dysfunction in children and adults. Accurate diagnosis is dependent on a thorough funduscopic examination, but can be enhanced by imaging information garnered from optical coherence tomography (OCT). We review common congenital optic nerve anomalies, including optic disc pit, optic nerve coloboma, morning glory disc anomaly, and hypoplasia of the optic nerve, review their systemic associations, and discuss insights from OCT imaging.

RECENT FINDINGS

Optic disc pits are a result of a defect in the lamina cribrosa and abnormal vitreomacular adhesions have been shown to cause maculopathy. In patients with optic nerve colobomas, OCT can be instrumental in diagnosing choroidal neovascularization, a rare but visually devastating complication. The pathogenesis of morning glory disc anomaly has been more clearly elucidated by OCT as occurring from a secondary postnatal mesenchymal abnormality rather than only the initial neuroectodermal dysgenesis of the terminal optic stalk in isolation. OCT studies of optic nerve hypoplasia have demonstrated significant thinning of the inner and outer retinal layers of the perifoveal region and thicker layers in the fovea itself, resulting in a foveal hypoplasia-like pathology, that is, significantly correlated to poorer visual outcomes.

SUMMARY

OCT provides detailed in-vivo analysis of these anatomic anomalies and their resulting pathologies, shedding new insights on the pathogenesis, diagnosis, and potential visual outcomes of these conditions in children. Further study employing OCT to elucidate structure-function relationships of congenital optic nerve anomalies will help expand the role of OCT in clinical practice related to diagnosis, prognosis, and management of these entities.

Morning glory disc anomaly with an ipsilateral enlargement of the optic nerve pathway

PURPOSE

To report three patients with an unilateral morning glory disc anomaly in association with an ipsilateral mild thickening of the optic nerve.

METHODS

Three children with a morning glory disc anomaly underwent a magnetic resonance imaging (MRI) of the brain. Ophthalmological, genetic and MRI findings at follow-up are reported. A literature search on the association of morning glory anomaly in association with optic nerve glioma is reported.¹ RESULTS: Three children with an unilateral morning glory anomaly and ipsilateral poor visual acuity were found to have an ipsilateral mild optic nerve enlargement on brain MRI. At serial MRI scanning, there was no progression of this finding.

CONCLUSIONS

The morning glory disc anomaly is a rare congenital malformation of the optic disc. It can be associated with central nervous system abnormalities. The association with an optic nerve glioma has been described once before.¹ Our three cases confirm the possible association between a morning glory disc anomaly and an ipsilateral optic nerve enlargement. Serial MRI showed no growth at follow-up. The awareness of this association by the ophthalmologists is important.

Study of the Radial Peripapillary Capillary Network in Congenital Optic Disc Anomalies With Optical Coherence Tomography Angiography

PURPOSE

To evaluate the radial peripapillary capillary network with optical coherence tomography angiography (angio-OCT) in morning glory syndrome (MGS), optic disc colobomas, and optic disc pits, and to explore possible correlations between the neural vascular structure and the pathogenesis of congenital optic disc anomalies.

DESIGN

Prospective observational comparative case series.

METHODS

Fifteen eyes of 15 patients with congenital optic disc anomalies were enrolled in this study. All patients underwent angio-OCT. The scans were centered on optic discs.

RESULTS

The mean age at presentation was 33 years (range: 19-50 years). Congenital optic disc anomalies were identified in all 15 eyes. Three eyes had the characteristic funduscopic signs of MGS, and angio-OCT scans of the peripapillary retina revealed a dense microvascular network. Optic disc colobomas were found in 5 eyes, and the characteristic funduscopic signs of optic pits were found in 7 eyes. Angio-OCT showed the absence of a radial peripapillary microvascular network in these 12 eyes.

CONCLUSION

The finding that angio-OCT scans confirmed the presence of a peripapillary microvascular network only in MGS cases supports the hypothesis that a primary neuroectodermal abnormality and a secondary mesenchymal abnormality leads to MGS. Angio-OCT is a safe, rapid imaging technique that could shed light on the pathogenesis of rare diseases of the optic disc.

Retinal complications associated with congenital optic disc anomalies determined by swept source optical coherence tomography

Optical coherence tomography has evolved over the past 2 decades to be an important ancillary method to evaluate diseases of the anterior and posterior segments of the eye. The more recent development of swept-source optical coherence tomography (SS-OCT) with a wavelength-tunable laser centered at 1050 nm and deeper imaging depth of 2.6 mm has enabled clinicians to evaluate congenital optic disc anomalies including optic disc pits, optic disc colobomas, and morning glory syndrome in more detail. The SS-OCT findings of the posterior precortical vitreous pocket, Cloquet's canal, lamina cribrosa that is torn from the peripapillary sclera, and the retrobulbar subarachnoid space immediately posterior to the highly reflective tissue lining the bottom of the excavation are presented. In addition, abnormal communications between the vitreous cavity and the subretinal and subarachnoid spaces in eyes with congenital optic disc anomalies are also reviewed. The retinal complications associated with congenital optic disc anomalies are treated by vitreous surgery, silicone oil tamponade, and peripapillary laser photocoagulation or scleral buckling. However, the surgical outcomes are limited and not entirely satisfactory. Analyses by SS-OCT of congenital optic disc anomalies should make the treatment correspond better with the pathological findings.

Morning Glory Syndrome with Carotid and Middle Cerebral Artery Vasculopathy

PURPOSE

To report a case of incidental asymptomatic atypical morning glory syndrome (MGS) with concomitant ipsilateral carotid and middle cerebral dysgenesis.

CASE REPORT

A 6-year-old child was discovered to have incidental findings of MGS, with atypia. All visual functions were normal including vision and stereopsis. Neuroimaging revealed ipsilateral carotid and middle cerebral vascular narrowing without associated collateral vessels or cerebral ischemia commonly seen in Moyamoya disease. Subsequent annual examinations have been stable, without signs of progression.

CONCLUSIONS

This case demonstrates disparity between structural aberrations and final visual and neurological function and reinforces the association between MGS and intracranial vascular disruption. Full ancillary ophthalmic and neuroimaging studies should be performed in all patients with MGS with interval reassessments, even when the patient is asymptomatic and functionally intact.

Morning glory disc anomaly in childhood - a population-based study

PURPOSE

To report prevalence, ocular characteristics and coexisting neurological, behavioural, somatic and neuroradiological abnormalities in children and adolescents with morning glory disc anomaly (MGDA).

METHODS

In a cross-sectional population-based study, 12 patients with MGDA, aged 2-20 years, were identified. All 12 agreed to ophthalmological assessments including visual functions, refraction, fundus photography, optical coherence tomography (OCT) and ocular motor score (OMS). Neurological examinations and behavioural/developmental screening were carried out. Data from previous or new neuroradiological investigations were collected.

RESULTS

The prevalence of MGDA was 2.6/100 000. MGDA was unilateral in 11/12 patients with a best-corrected visual acuity (BCVA) in the MGDA eye ranging from hand motion to 0.65 (median 0.06). Severe microphthalmus prevented unilaterality to be determined in one adolescent. All patients had a binocular BCVA of ≥0.5. OMS showed abnormalities in pupil response, vestibulo-ocular reflex, stereo visual acuity, strabismus and convergence. OCT revealed peripapillary or macular oedema in 5/8 patients and foveal aplasia in 3/8 patients. Three patients had extensive capillary hemangiomas, of which one had PHACES syndrome and one had additional cerebrovascular anomalies and corpus callosum agenesis. Neuroradiology showed craniovascular anomalies in two patients. Neurology was mostly normal. Behavioural/developmental screening showed attention deficit hyperactivity disorder in one patient.

CONCLUSIONS

The prevalence data, previously not reported, of morning glory disc anomaly was 2.6/100 000. Coexisting retinal peripapillary or macular oedema was common, as were cerebral abnormalities and/or cutaneous vascular malformations. The associated findings may not be discovered through routine ophthalmological examination why OCT and neuroimaging are called for.

Perfluorocarbon liquid migration into the subarachnoid space in a patient with morning glory syndrome

Purpose

To report a case of perfluorocarbon liquid (PFCL) migration into the subarachnoid space at the time of vitreoretinal surgery in a patient with morning glory syndrome associated retinal detachment.

Case report

A 9-year-old girl underwent pars plana vitrectomy and silicone oil injection for retinal detachment associated with morning glory syndrome. PFCL was used for retinal stabilization before endolaser photocoagulation. The retina detached, and repeated vitrectomy and silicone oil injection was performed. Postoperative magnetic resonance imaging revealed PFCL in the subarachnoid space.

Conclusion

The migration of perfluorocarbon into the subarachnoid space is a rare complication of vitrectomy in patients with morning glory syndrome.

Enhanced depth imaging optical coherence tomography of congenital cavitary optic disc anomaly (CODA)

AIM

To report the finding of extension of the 4th hyper-reflective band and retinal tissue into the optic disc in patients with cavitary optic disc anomalies (CODAs).

METHODS

In this observational study, 10 patients (18 eyes) with sporadic or autosomal dominant CODA were evaluated with enhanced depth imaging optical coherence tomography (EDI-OCT) and colour fundus images for the presence of 4th hyper-reflective band extension into the optic disc.

RESULTS

Of 10 CODA patients (18 eyes), five patients (8 eyes) showed a definite 4th hyper-reflective band (presumed retinal pigment epithelium (RPE)) extension into the optic disc. In these five patients (seven eyes), the inner retinal layers also extended with the 4th hyper-reflective band into the optic disc. Best corrected visual acuity ranged from 20/20 to 20/200. In three patients (four eyes), retinal splitting/schisis was present and in two patients (two eyes), the macula was involved. In all cases, the 4th hyper-reflective band extended far beyond the termination of the choroid into the optic disc. The RPE extension was found either temporally or nasally in areas of optic nerve head excavation, most often adjacent to peripapillary pigment. Compared with eyes without RPE extension, eyes with RPE extension were more myopic (mean dioptres -0.9±2.6 vs -8.8±5, p=0.043).

CONCLUSIONS

The RPE usually stops near the optic nerve border separated by a border tissue. With CODA, extension of this hyper-reflective band and retinal tissue into the disc is possible and best evaluable using EDI-OCT or analogous image modalities. Whether this is a finding specific for CODA, linked to specific gene loci or is also seen in patients with other optic disc abnormalities needs further evaluation.

Evaluation of congenital excavated optic disc anomalies with spectral-domain and swept-source optical coherence tomography

PURPOSE

To investigate the anatomic characteristics of congenital excavated optic disc anomalies by using fundus photography, spectral-domain optical coherence tomography (SD-OCT), and swept-source optical coherence tomography (SS-OCT).

METHODS

Fourteen eyes from 13 patients with congenital excavated optic disc anomalies underwent a complete ophthalmologic examination that included best-corrected visual acuity evaluation, fundus photography, and SD-OCT. SS-OCT was performed in cases of peripapillary staphyloma cases in which the excavation depth could not be detected with SD-OCT. On the basis of the funduscopic and OCT findings, patients were classified as morning glory syndrome, optic disc coloboma, or peripapillary staphyloma.

RESULTS

Seven eyes with morning glory syndrome were characterized by the presence of the preretinal tractional membrane in front of the excavated optic disc and could be divided into two groups: three eyes without retinal excavation, and four eyes with retinal excavation. Four eyes with optic disc coloboma showed inferiorly decentered scleral excavations with shallow optic disc excavation detectable by SD-OCT. Three eyes with peripapillary staphyloma showed deep excavation, the depth of which could not be detected by SD-OCT. SS-OCT and enhanced depth imaging SD-OCT images focused on the bottom revealed membranous structure at the bottom of the excavation in two cases with peripapillary staphyloma.

CONCLUSIONS

SD-OCT and SS-OCT are helpful for differential diagnosis of excavated optic disc anomalies. Morning glory syndrome, optic disc coloboma, and peripapillary staphyloma were respectively characterized by the presence of a preretinal tractional membrane, inferiorly decentered excavation, and an excavation deeper than that observed in morning glory syndrome and optic disc coloboma.

Unilateral morning glory optic disc anomaly in a case with Down syndrome

BACKGROUND

This case is unique because it is the first reported case of Down syndrome with morning glory optic disc anomaly in literature.

CASE PRESENTATION

A 15-year-old girl with features of Down syndrome presented to the Clinic of Ophthalmology for a regular ophthalmologic examination. Her best corrected visual acuity was 20/50 in the right eye and 20/20 in the left eye. The fundus examination revealed findings compatible with unilateral morning glory optic disc anomaly in the right eye. The patient underwent a complete ophthalmologic and systemic evaluation to explore possible associated findings.

CONCLUSION

This case report emphasizes the importance of ophthalmic screening-examinations in Down children to rule out any vision relevant pathology.

Retinal detachment associated with optic disc colobomas and morning glory syndrome

We report the diagnosis and treatment of patients with retinal detachment and/or retinoschisis associated with optic nerve coloboma or morning glory syndrome. A retrospective review of patients with optic nerve coloboma or morning glory syndrome with associated retinal detachment or retinoschisis was conducted. For five patients (six eyes), we report the clinical findings, spectral domain optical coherence tomography (OCT) imaging, intraoperative findings, and treatment outcomes. OCT scans demonstrate a bilaminar structure of maculopathy, consisting of inner schisis-like changes and outer layer retinal detachment. In most cases, a retinal break was demonstrated within the optic disc defect with three-dimensional OCT imaging. Glial tissue was sometimes observed within the anomalous defect. Vitrectomy and resection of the tractional tissue in these cases produced good anatomical and visual outcomes. Retinal detachment spontaneously resolved in cases where traction was not present. Traction may contribute to the pathogenesis of retinal detachment associated with colobomatous optic disc anomalies, either directly or by creating a secondary retinal break. OCT imaging assists with understanding the contributing factors to retinal detachment in individual cases of colobomatous optic disc anomalies and can thereby assist with determining the most effective approach to management.

Retinal detachment in morning glory syndrome with large hole in the excavated disc

PURPOSE

To present a case of morning glory syndrome (MGS) associated with retinal detachment and to discuss the pathogenesis of retinal tear.

METHODS

A 2-year-old-girl had a MGS with a large hole in the excavated disc and retinal detachment. The visual acuity was 4/200 in the affected eye. The excavated disc and retinal detachment were confirmed by echogram. Optical coherence tomography demonstrated that the large hole was connected to the subretinal space. The excavated lesion did not show contractions. The detachment area and the volume of subretinal fluid rose and fell between initial examinations, but ultimately increased. After 2 years of observations, surgery was performed as the retinal detachment had enlarged to include the macula.

RESULTS

Surgery included triamcinolone-assisted vitrectomy, subretinal fluid drainage through the large hole in the excavated disc, retinal photocoagulation along the excavated disc, and long-acting gas tamponade. One month later, the retina was redetached due to incomplete closure of the hole. A second operation was performed using silicone oil tamponade. Ultimately, the retina was reattached after silicone oil-fluid exchange surgery.

CONCLUSIONS

One possible reason for a large hole in an excavated disc is origination of the tear from a congenital defect, such as an optic pit. The retinal detachment in patients with MGS with a large hole in the disc can be treated with triamcinolone-assisted pars plana vitrectomy and retinal photocoagulation along the excavated disc. This case has shown that one critical component for a high success rate is the tamponade agent used in the vitreous.

Optic disc contractility in morning glory disc anomaly

Morning glory disc anomaly is a sporadic congenital abnormality of the optic disc that is often unilateral. These eyes possess heterotropic smooth muscle and can undergo spontaneous contraction with transient vision loss. The authors report an unusual case of contractility of a morning glory disc anomaly induced by ocular massage.