The systemic and genetic significance of congenital optic disc anomalies

The prevalance of congenital optic disc anomalies in Turkey: a hospital-based study

PURPOSE

The aim of this study was to investigate the prevalence of congenital optic disc anomalies in Turkey.

METHODS

The 11,123 eyes of 5570 patients were screened for optic disc anomalies. All patients were underwent a complete ophthalmic examination including best corrected visual acuity, refraction, spherical equivalent, slit lamp biomicroscopy, intraocular pressure measurements, dilated stereoscopic fundus examination. Data analyses were performed by using SPSS for Windows, version 22.0 (SPSS Inc., Chicago, IL, United States).

RESULTS

11,123 eyes of 5570 participants were screened. Of the 5570 participants who underwent optic disc examination, 246 eyes of 174 patients (3.12%, 95% CIs 2.66-3.58%) had optic disc anormalies. 92 (52.9%) were female, 82 (47.1%) were male and the mean of age was 44.25 ± 15.67 years. 72 (41.4%) patients were bilateral, 102 (58.6%) patients were unilateral involvement. The tilted disc was the most common anomaly and was found at least one eye in 46 patients (75 eyes) and 0.83% of all screened patients. Peripapillary myelinated nerve fibers was the second common anomaly and was found at least one eye in 31 subjects (35 eyes) and 0.56% of all screened subjects. Peripapillary atrophy was the third common anomaly, and was found in at least one eye in 24 patients (37 eyes) and 0.43% of all screened subjects.

CONCLUSION

To our knowledge, this is the first study that the prevalences of all congenital optic disc anomalies from Turkey. The prevalence of congenital optic disc anomalies is higher than in other countries.

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.

SOLITARY RETINAL CAPILLARY HEMANGIOMA IN A PATIENT WITH BILATERAL CHORIORETINAL COLOBOMA

PURPOSE

To report a case showing a very rare association of chorioretinal coloboma and retinal capillary hemangioma in a previously healthy patient.

METHODS

Observational case report.

RESULTS

A 21-year-old woman presented at our clinic for vision screening. She had a history of bilateral chorioretinal coloboma with amblyopia in her left eye. Her best-corrected visual acuity was 20/25 in her right eye and 20/200 in her left eye. On slit-lamp examination, iris coloboma was observed in the left eye. Fundus evaluation showed inferior chorioretinal coloboma in both eyes, and an elevated, round, and orange-red retinal lesion with feeder vessels localized in the midperipheral region of the right eye. The patient was diagnosed as having solitary retinal capillary hemangioma and underwent argon laser therapy for treating the tumoral lesion. Diagnostic studies were negative for von Hippel-Lindau disease. This is the first reported case of solitary retinal capillary hemangioma associated with bilateral chorioretinal coloboma.

CONCLUSION

Chorioretinal coloboma is a congenital defect of the eye caused by improper closure of the embryonic fissure. Retinal capillary hemangioma is a vascular retinal tumor that may occur sporadically or as part of the von Hippel-Lindau syndrome. We report a rare association of chorioretinal coloboma and retinal capillary hemangioma in a previously healthy patient.

Rare bilateral presentation of morning glory disc anomaly

A 4-year-old girl presented with a history of poor vision and oscillation of both eyes since infancy. Ocular examination revealed the best corrected visual acuity of 2/60 in right eye and 3/60 in left eye. Horizontal pendular nystagmus was present in both eyes. Fundus examination revealed morning glory disc anomaly (MGDA) bilaterally. Radiographic imaging of the brain revealed central nervous system anomalies. The guarded visual prognosis was explained and the patient referred for low vision rehabilitation and advised yearly follow-up. MGDA is very rarely bilateral. We aim to highlight the distinguishing features of bilateral MGDA from other excavated optic nerve head anomalies which could also present bilaterally but vary in their associations, management and prognosis.

Morning glory syndrome associated with posterior lenticonus

The clinical features of the morning glory syndrome (MSG) are demonstrated in a 12-year-old male patient with the posterior lenticonus in the left eye. This patient had retinal detachment in the left eye. A complete ocular examination was performed and the patient underwent a pars plana vitrectomy of the left eye. Slit-lamp examination revealed the posterior lenticonus with the posterior subcapsular opacities in the left eye. The fundus showed the symptoms of MGS. The discs were pink and deeply excavated, surrounded by a ring of chorioretinal pigmentary disturbance. The retina has remained reattached for six months after surgery. Although most cases of MGS present with retinal and vitrea abnormalities, it may also occur in association with the lens anomalies, including the posterior lenticonus and subcapsular cataract. This association may be helpful to explore the pathogenesis of MGS.

Clinical Feature Analysis of Congenital Optic Nerve Abnormalities

PURPOSE

We investigated the clinical characteristics and associated ocular and systemic anomalies in young children with congenital optic nerve abnormalities, and evaluated the therapeutic results of treatment for strabismus and amblyopia.

METHODS

A retrospective study was conducted using the medical records of patients who were diagnosed with congenital optic nerve abnormalities in our hospital between 1995 and 2004.

RESULTS

This study involved 72 eyes of 51 young children (M : F = 25 : 26); 21 of these patients (41.2%) had bilateral abnormalities. The types and percentages of each abnormality were as follows: optic nerve hypoplasia, 47%; optic disc coloboma, 31.4%; morning glory syndrome, 11.8%; and myelinated nerve fiber, 9.8%. The first clinical manifestations noticed by parents were strabismus and decreased visual acuity. Occlusion therapy was carried out in 16 patients, and the visual acuities of two patients were improved by more than two lines of the Early Treatment Diabetic Retinopathy Study visual acuity chart. Accompanying strabismus was found in 70.6% of the patients; 14 patients underwent strabismic surgery, and 10 of these patients (41.2%) maintained a stable angle.

CONCLUSIONS

The most common congenital optic nerve abnormality was optic nerve hypoplasia, and the associated systemic abnormalities found were optic nerve hypoplasia and disc coloboma. Patients with congenital optic nerve abnormalities usually have a generally poor visual prognosis, but we emphasize the importance of treatment for associated strabismus and amblyopia.

Morning glory syndrome

Morning glory syndrome is a congenital optic disc anomaly in which much of the excavated colobomatous optic disc is filled with glial tissue. Ocular complications may include strabismus, reduced visual acuity and retinal detachment and it may have systemic associations as in Aicardi's syndrome. A patient with monocular morning glory syndrome and reduced visual acuity is reported. The pattern reversal visually evoked potential was reduced and the latency increased in the affected eye.

Ocular colobomata

Ocular colobomata present diagnostic and therapeutic challenges in patients of all ages, but especially in young children. The "typical" coloboma, caused by defective closure of the fetal fissure, is located in the inferonasal quadrant, and it may affect any part of the globe traversed by the fissure from the iris to the optic nerve. Ocular colobomata are often associated with microphthalmia, and they may be idiopathic or associated with various syndromes. Types and severity of complications vary depending on the location and size of the colobomata. This article reviews the pathogeneses, categorization, genetic bases, differential diagnoses and management of ocular coloboma.

Chorioretinal colobomas in a pediatric population

OBJECTIVE

The purpose of the study was to determine the prevalence of retinal detachment and associated anomalies in pediatric patients with chorioretinal colobomas.

DESIGN

Observational case series.

PARTICIPANTS

Forty-eight patients (86 eyes) of patients with chorioretinal colobomas followed in two academic pediatric eye clinics were reviewed.

MAIN OUTCOME MEASURES

The frequency of associated systemic abnormalities and the prevalence of retinal or choroidal detachment during the follow-up period.

RESULTS

Forty-eight patients (86 eyes) were identified; ocular involvement ranged from small colobomas with isolated chorioretinal involvement to large colobomas affecting the iris, choroid, retina, and optic nerve. The mean ages at initial and most recent examinations were 27 and 100 months, respectively. Follow-up averaged 6 years, 1 month. Six retinal detachments were found in four patients. Patient ages at the time of detection of retinal detachment were 5 months, 29 months, 10 years, and 15 years. A choroidal detachment was found in a child at age 9 years. The combined prevalence of retinal or choroidal detachment was 10.4% of patients and 8.1% of affected eyes. Thirteen eyes were microphthalmic, and six had microcornea. Eighteen patients (38%) had other systemic abnormalities.

CONCLUSIONS

The 8.1% prevalence of retinal or choroidal detachment among eyes in our series was much smaller than previously cited estimates of 23% to 43%. The higher figures probably reflect a referral bias toward patients with vitreoretinal problems and an older patient population. Because of the acknowledged difficulty of managing retinal detachments in patients with chorioretinal colobomas, emphasis should be directed toward early detection and possible prophylactic therapy. The high proportion of patients who have associated systemic abnormalities indicates the need for thorough evaluation of these children by other pediatric specialists.

Eye malformations associated with treatment with carbamazepine during pregnancy

Four children are presented and their eye malformations described. One girl had bilateral anophthalmos, a boy and a girl had bilateral severe microphthalmos, and a boy had a unilateral optic disc coloboma. The mothers of all for children were treated with carbamazepine during pregnancy. The teratogenic effect of carbamazepine and its likely role in the genesis of the eye malformations is discussed.