Moyamoya disease presenting to the ophthalmology clinic

Moyamoya Disease Associated With Morning Glory Disc Anomaly and Other Ophthalmic Findings: A Mini-Review

Moyamoya disease (MMD) is a chronic cerebrovascular disease that frequently results in intracranial ischemia or hemorrhage. Its concurrence with varying ophthalmic findings is relatively rare yet may lead to irreversible blindness. We performed a search and review of the literature to characterize the relevance of MMD (excluding moyamoya syndrome) and ophthalmic findings. As a result, a total of 38 articles identified from PubMed and Web of Science were included in this mini-review. Patients with MMD sometimes present with decreased visual acuity or visual field defects before the onset of symptomatic cerebrovascular dysfunction. The most predominant ophthalmic condition in MMD patients is the morning glory disc anomaly (MGDA). Deficiency during neuroectodermal genesis and subsequent mesodermal changes may be responsible for the association between these two diseases. Thus, it may be beneficial for patients with MGDA to receive cerebral vascular examinations as the precaution against life-threatening intracranial angiopathy. Other ophthalmic findings reported in cases of MMD include retinal vascular occlusion, optic disc pallor, cortical blindness, etc. For most of the patients with MMD, retinal examinations would be recommended to prevent potential loss of vision. It is essential for both neurologists and ophthalmologists to be aware of the correlation between cerebrovascular diseases such as MMD and ocular manifestations to achieve a comprehensive diagnosis.

Acquired unilateral visual deterioration: More to ischemia than meets the eye

A 56-year-old woman presented with visual loss in the right eye with best-corrected visual acuity of 20/40. Funduscopic examination revealed neovascularization of the disk with peripapillary preretinal hemorrhages and leakage on fluorescein angiography. Cerebral arteriography demonstrated stenosis of the major cerebral vessels with classic collaterals configuring as "puff of smoke." A diagnosis of moyamoya-related ocular ischemic syndrome manifesting with optic disk neovascularization was made.

A Moyamoya Patient with Bilateral Consecutive Branch Retinal Vein Occlusion

We describe a moyamoya (MMD) patient with bilateral consecutive branch retinal vein occlusion (BRVO). The patient had a medical history of severe headache, cranial haemorrhage, bilateral supraclinoid carotid artery occlusion, and "puff of smoke" collaterals on cerebral angiography and an encephalomyosynangiosis operation. On ophthalmic examination, he had superior temporal branch vein occlusion with intraretinal haemorrhage and visual acuity of 20/25 in the right eye. Twelve years later, he presented with superior temporal branch vein occlusion in the left eye and visual acuity of 20/60. The patient was initially treated with a dexamethasone intravitreal implant, and later intravitreal ranibizumab injections. We describe the first reported case of bilateral consecutive BRVO and management in MMD.