Three cases of the morning glory syndrome

A mechanosensitive peri-arteriolar niche for osteogenesis and lymphopoiesis

Leptin Receptor⁺ (LepR⁺) stromal cells in adult bone marrow are a critical source of growth factors, including Stem Cell Factor (SCF), for the maintenance of hematopoietic stem cells (HSCs) and early restricted progenitors^1–6. LepR⁺ cells are heterogeneous, including skeletal stem cells, osteogenic, and adipogenic progenitors^7–12, though few markers have been available to distinguish these subsets or to compare their functions. Here we show expression of an osteogenic growth factor, Osteolectin^13,14, distinguishes peri-arteriolar LepR⁺ cells poised to undergo osteogenesis from peri-sinusoidal LepR⁺ cells poised to undergo adipogenesis (but retaining osteogenic potential). Peri-arteriolar LepR⁺Osteolectin⁺ cells are rapidly dividing, short-lived, osteogenic progenitors that increase in number after fracture and are depleted during aging. Deletion of Scf from adult Osteolectin⁺ cells did not affect the maintenance of HSCs or most restricted progenitors but depleted common lymphoid progenitors (CLPs), impairing lymphopoiesis, bacterial clearance, and survival after acute bacterial infection. Peri-arteriolar Osteolectin⁺ cell maintenance required mechanical stimulation. Voluntary running increased, while hindlimb unloading decreased, the frequencies of peri-arteriolar Osteolectin⁺ cells and CLPs. Deletion of the mechanosensitive ion channel, Piezo1, from Osteolectin⁺ cells depleted Osteolectin⁺ cells and CLPs. A peri-arteriolar niche for osteogenesis and lymphopoiesis in bone marrow is maintained by mechanical stimulation and depleted during aging.

A peri-arteriolar niche in the bone marrow for osteogenesis and lymphopoiesis is maintained by mechanical stimulation and is depleted during aging.

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.

Morning glory syndrome: a histopathological study

The clinical and histopathological findings in a case of morning glory syndrome are described. Axial optic nerve retrodisplacement into a peripapillary scleral ectasia (staphyloma), absence of fibrous lamina cribrosa, and optic nerve atrophy were associated with various other, non-inherent ocular developmental anomalies. The uninterrupted lining of the inner wall of the staphyloma by one-layered, normal retinal pigment epithelium proves that the syndrome is not due to a neuroectodermal closure defect.

Papillo-renal syndrome. An inherited association of optic disc dysplasia and renal disease. Report and review of the literature

A family is described in which the father and son had chronic renal disease of early onset and bilateral optic nerve dysplasia. A further son, known to have microphthalmos died of renal disease in childhood. Optic nerve changes included coloboma in the father and Handmann's optic nerve anomaly, a condition resembling the morning glory syndrome (M.G.S.), in the son. There was electrodiagnostic and visual field evidence of optic nerve dysfunction even where acuity was relatively unaffected. The son developed central serous retinopathy, a condition frequently encountered in association with optic nerve dysplasias, including M.G.S.

The spectrum in the morphology of the so-called "morning glory disc anomaly"

Eight cases illustrating the different configurations of the morning glory disc anomaly are presented. The spectrum of the appearance is due to variability in excavation of the disc, amount of glial tissue and hyaloid system remnants in the center of the disc, and degree of peripapillary pigmentary changes. There is no correlation between optic disc configuration and visual acuity. This anomaly should be suspected in infants presenting with unilateral retinal detachment.

Morning glory disc anomaly with pulsating peripapillary staphyloma. A case history

A case of morning glory disc anomaly with pulsating peripapillary staphyloma is reported and the literature reviewed. The aetiology of this malformation remains a problem.

The morning glory disc anomaly: contractile movement, classification, and embryogenesis

A case of the morning glory disc anomaly is reported in which alternating contraction and dilation movements were observed and documented with fundus photographs. The movements are attributed to an anomalous communication between the subretinal and subarachnoid spaces that permits flux of fluid to occur between the two compartments, with consequent variation in the degree of retinal elevation within the excavated portion of the lesion. The clinical features of the morning glory disc anomaly, peripapillary staphyloma and optic disc coloboma are presented, and the relationship among these lesions is discussed. The author concludes that the morning glory disc anomaly is a clinical entity distinct from peripapillary staphyloma and optic disc coloboma. It is thought to be due to dysgenesis of the distal optic stalk leading to anomalous persistence of the extension of the cavity of the optic cup into the stalk.

Morning glory syndrome: clinical and electrofunctional study of three cases

Three cases of morning glory syndrome are described and some new electrofunctional and tomodensitometric findings are reported. The amplitude of the waves of the electroretinogram is reduced and correlates with the extension of the retinal changes. The visually evoked potentials elicited with bright flashes have normal latencies but generally subnormal amplitudes. The amplitude of the potentials probably depends on the degree of involvement of the optic nerve. The computerised tomography performed in one patient disclosed undescribed changes in the retrobulbar optic nerve.

Ocular and systemic abnormalities associated with morning glory syndrome

The term: 'morning glory syndrome' is currently used to describe a clinical complex encompassing a primarily congenital, possibly hereditary optic nerve anomaly associated with other ocular and systemic abnormalities. This syndrome has been shown to be usually limited to the eye with non-involvement of the retrobulbar nerve and brain. However, recent studies have illustrated that morning glory syndrome may be associated with such systemic abnormalities as sphenoidal encephalocele. The authors present a review of the current literature and functionally analyze the incidence of retinal detachment, pre-retinal gliosis, increased production of fibrovascular tissue and other ocular abnormalities; as well as exploring the association of systemic involvement; utilizing fluorescein angiography, computerized tomography, ultrasonography and electrophysiology.

The 'morning glory' syndrome

This paper discusses the characteristic features of 'morning glory' syndrome, observed in 49 patients, described in the literature and in three personal observations. 'Morning glory' syndrome is frequently associated with strabismus (20/49 patients), non-rhegmatogenous retinal detachment (13/56 eyes) or remnants of the hyaloid system (10/56 eyes). Association with basal encephalocele has been encountered three times. The 'morning glory' syndrome usually affects only one eye, although four bilateral cases have been described. The family history was negative, except in the cases discussed by Handmann (1929) and by Rieger (1977), where father and son presented the optic disc anomaly. In Rieger's family there was also familial renal hypoplasia. Morning glory syndrome is not to be considered as a true coloboma, but rather as a posterior ectasia, due to disturbance in the development of the sclera.

An unusual case of congenital unilateral Coats's disease associated with morning glory optic disc anomaly

We present the case of a 13-year-old girl with a right congenital esotropia who at the age of 6 months presented an anomaly of the optic disc and retinal vessels in the same eye. In the following year she developed Coats's disease, rubeosis iridis, and neovascular glaucoma that led to enucleation. Pathological examination confirmed the clinical diagnosis.

Retinal detachment in the morning glory anomaly

The morning glory anomaly is a rare congenital clinical entity that results from abnormal optic nerve development. In our series of 30 patients, followed for a mean duration of 10.3 years, 11 developed associated retinal detachments. These detachments followed a variable clinical course, including spontaneous reattachment and even redetachment, and may result from an abnormal communication between the subarachnoid space of the optic nerve and the subretinal space, allowing cerebrospinal fluid to accumulate subretinally. The clinical findings (including ultrasonography, computed tomography, and electrophysiologic testing), natural history, complications, and therapeutic indications are discussed.

Treatment of total retinal detachment in morning glory syndrome

A 14-year-old girl had headaches and sudden loss of vision as a result of total retinal detachment in association with the morning glory optic nerve anomaly. Metrizamide cisternography with contrast dye introduced into the subarachnoid space disclosed migration of metrizamide with radiographic enhancement in the subretinal space. The demonstration of an abnormal communication between the subarachnoid and subretinal spaces suggested that the subretinal fluid is of cranial origin. The patient underwent surgical removal of a window of dura from the optic nerve sheath. This resulted in retinal reattachment and improvement of visual acuity to 20/200. The retina was still attached after a 15-month follow-up period.

Basal encephalocele and morning glory syndrome

Basal encephaloceles are often associated with other midline anomalies such as hypertelorism, broad nasal root, cleft lip, and cleft palate. Optic disc anomalies such as pallor, dysplasia, optic pit, coLoboma, and megalopapilla have been reported to occur in patients with basal encephalocele We report a case of a child with a sphenoethmoidal encephalocele and morning glory syndrome of the optic nerve. The presence of such optic nerve anomalies with facial midline anomalies should alert the clinician to the possible presence of a basal encephalocele.

Acute morning glory syndrome: report of a case

In 1976 a boy of 12 presented with unilateral morning glory syndrome connected with oedema of the posterior fundus and marked loss vision. The recovery was complete within a few months, with visual acuity improving to 6/4. The other eye could see 6/4 and had a normal fundus throughout.

The morning glory syndrome associated with sphenoidal encephalocele

A 13-year-old girl was found to have a "morning glory" optic disc anomaly associated with remnants of the primitive hyaloid vasculature, midline cleft lip and palate, agenesis of the corpus callosum, and a sphenoidal encephalocele. The association of these developmental anomalies indicates that the "morning glory" optic disc anomaly may occur as part of a more extensive syndrome of midline cranioencephalic dysraphism.

Congenital anomalies of the optic disc

Although anomalies affecting the optic nerve head are usually clinically innocuous, they can sometimes cause significant symptoms and lead to visual loss. It is important to be able to recognize even the relatively benign lesions in order to differentiate them from other more threatening lesions or disease processes which they may clinically resemble. An awareness of the clinical appearance of disc anomalies is especially important in the differential diagnosis of optic nerve glaucomatous changes. Some anomalies cause various types of visual field loss which, if the actual disc lesion is not recognized, may lead to unnecessary neurologic evaluation or even to intracranial surgery. The optic nerve changes in acquired myopia and in the congenital tilted disc syndrome should be clearly defined and differentiated: high (pathologic) myopia may be highly progressive with many dangerous secondary sequelae, while the latter anomaly is stationary. Finally, there is a group of conditions, collectively termed "elevated anomalies of the disc," which must be considered in the differential diagnosis of papilledema and potentially dangerous intraocular tumors, particularly retinoblastoma. This review provides a clinicopathologic correlation comparing the characteristics of the normal optic disc to those of the most important congenital anomalies of the disc.

Duane's retraction syndrome associated with morning glory syndrome

A 9-year-old boy with Duane's retraction syndrome and morning glory syndrome is presented. The right eye showed a grayish-pink optic disc, which had a deep excavation containing a white mass in its center and was surrounded by an annulus of pigment disturbance, i.e., consistent with the features of morning glory syndrome. The left eye had a congenital disturbance of ocular motility, which was typical of Duane's retraction syndrome. This is probably the first report of the association of Duane's retraction syndrome and morning glory syndrome. It is hypothesized that a noxious stimulus given at around two months of gestation was responsible for this rare association.

Coloboma of optic nerve with overlay of peripapillary retina

An eye that had the clinical appearance of a tumour of the nerve head was found on histological examination to have a congenitally large scleral canal with secondary buckling of the overlying retina.

Congenital anomalies of the optic disk

Six patients had congenital anomalies of the optic disk: epipapillary fibrous tissue, peripapillary pigmentary disturbance, and anomalies in the size of the optic disk and in the retinal vessels. Congenital anomalies of the optic disk form a spectrum in which many of the ophthalmoscopic features are shared and in which visual function varies.