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Firouzabadi FD, Soldatelli MD, Rameh V, Heidary G, Vargas SO, Gonzalez E, Rispoli J, Rahbar R, Robson CD. Morning Glory Disc Anomaly: Expanding the MR Phenotype. AJNR Am J Neuroradiol 2024; 45:1070-1075. [PMID: 38991766 DOI: 10.3174/ajnr.a8296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/18/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND AND PURPOSE Morning glory disc anomaly (MGDA) is a congenital malformation characterized by a funnel-shaped optic disc excavation with radiating vessels and a central glial tuft. Imaging is essential to evaluate associated cephalocele and steno-occlusive vasculopathy. The goal of this study was to assess optic nerve, chiasmatic, and sphenoid bone morphology in MGDA. MATERIALS AND METHODS This retrospective study examined all subjects with funduscopically confirmed MGDA diagnosed and imaged with brain MR imaging between 2008 and 2023. RESULTS Thirty-two children met inclusion criteria. Ocular involvement was unilateral in 29 subjects and bilateral in 3. Segmental optic nerve enlargement ipsilateral to the MGDA was seen in 21 subjects, with 3 also demonstrating a segmental reduction in the size of the ipsilateral optic nerve. Segmental reduction in the size of the ipsilateral optic nerve was present in 3 additional subjects, one with bilateral MGDA. The optic chiasm appeared asymmetrically thickened in 21 subjects, often with deformity. The optic nerves appeared normal in signal intensity in all subjects, with faint peripheral chiasmatic enhancement in 4 of 20 patients who received contrast. Optic nerve findings were stable in 15 subjects with multiple examinations. A persistent craniopharyngeal canal was identified in 17 subjects with sphenoid cephalocele in 1 and mild inferior pituitary gland displacement in 4. Tubular or nodular nasopharyngeal lesions were seen in 10 subjects. One subject had an off-midline sphenoid bone cleft, midbrain deformity, and abnormal thickening of and enhancement around the left oculomotor nerve; the oculomotor nerve finding was present in 1 additional patient. CONCLUSIONS MGDA often manifests with ipsilateral optic nerve thickening, leading to a potential misdiagnosis as optic glioma. MGDA is also commonly associated with a persistent craniopharyngeal canal with variable pituitary gland and infundibular deformity, cephalocele, and tubular or nodular nasopharyngeal lesions.
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Affiliation(s)
- F D Firouzabadi
- From the Department of Radiology (F.D.F., M.D.S. V.R., J.R., C.D.R.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Radiology and Biomedical Engineering (F.D.F.), University of San Francisco School of Medicine, San Francisco, California
| | - M D Soldatelli
- From the Department of Radiology (F.D.F., M.D.S. V.R., J.R., C.D.R.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - V Rameh
- From the Department of Radiology (F.D.F., M.D.S. V.R., J.R., C.D.R.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - G Heidary
- Department of Ophthalmology (G.H., E.G.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - S O Vargas
- Department of Pathology (S.O.V.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - E Gonzalez
- Department of Ophthalmology (G.H., E.G.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - J Rispoli
- From the Department of Radiology (F.D.F., M.D.S. V.R., J.R., C.D.R.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - R Rahbar
- Department of Otolaryngology (R.R.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
- Center for Communication Enhancement, (R.R.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - C D Robson
- From the Department of Radiology (F.D.F., M.D.S. V.R., J.R., C.D.R.), Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
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Caplash S, Paez-Escamilla M, Westcott M, Dansingani KK, Indermill C, Kisma N, Frau E, Sahel JA, Bodaghi B, Jhanji V, Errera MH. Mimickers of anterior uveitis, scleritis and misdiagnoses- tips and tricks for the cornea specialist. J Ophthalmic Inflamm Infect 2024; 14:14. [PMID: 38594487 PMCID: PMC11004105 DOI: 10.1186/s12348-024-00396-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 03/29/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Anterior uveitis, inflammation of the anterior chamber and related structures, is a cohort of diseases that can present to almost any general or sub-specialty Ophthalmology practice. Its features classically involve anterior chamber cell and flare. Below the surface of these two signs exist a panoply of diagnoses. BODY: The purpose of this review is to provide a general framework for diagnoses of anterior uveitis that are often missed as well as non-uveitic pathologies that often mimic anterior uveitis. Diagnostic deviation in either direction can have vision-threatening and rarely life-threatening consequences for patients. Using a comprehensive literature review we have collected a broad spectrum of etiologies of anterior uveitis that are easily missed and non-uveitic pathologies that can masquerade as anterior uveitis. CONCLUSIONS We present a focused review on specific misdiagnosed anterior uveitis pathologies and some of the conditions that can masquerade as anterior uveitis and scleritis.
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Affiliation(s)
- Sonny Caplash
- Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Manuel Paez-Escamilla
- Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Mark Westcott
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK
| | - Kunal K Dansingani
- Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Chad Indermill
- Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Nacima Kisma
- Universite Libre de Bruxelles, Hopital Universitaire de Bruxelles, 808 route de Lennik 1170, Bruxelles, Belgium
| | - Eric Frau
- Department of Ophthalmology, Centre hospitalier National des Quinze-Vingts, Paris, France
| | - Jose-Alain Sahel
- Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Bahram Bodaghi
- Department of Ophthalmology, Pitié-Salpêtrière University Hospital, Sorbonne Universités, F-75013, Paris, France
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Marie-Helene Errera
- Department of Ophthalmology, University of Pittsburgh, 203 Lothrop Street, Pittsburgh, PA, 15213, USA.
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3
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Cennamo G, Rinaldi M, Concilio M, Costagliola C. Congenital Optic Disc Anomalies: Insights from Multimodal Imaging. J Clin Med 2024; 13:1509. [PMID: 38592429 PMCID: PMC10932420 DOI: 10.3390/jcm13051509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/28/2024] [Accepted: 03/05/2024] [Indexed: 04/10/2024] Open
Abstract
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.
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Affiliation(s)
- Gilda Cennamo
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples “Federico II”, 80138 Napoli, Italy;
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80138 Napoli, Italy
| | - Michele Rinaldi
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples “Federico II”, 80138 Napoli, Italy;
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80138 Napoli, Italy
| | - Marina Concilio
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy;
| | - Ciro Costagliola
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples “Federico II”, 80138 Napoli, Italy;
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Hong J, Yoon S, Shim KW, Park YR. Screening of Moyamoya Disease From Retinal Photographs: Development and Validation of Deep Learning Algorithms. Stroke 2024; 55:715-724. [PMID: 38258570 PMCID: PMC10896198 DOI: 10.1161/strokeaha.123.044026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 12/13/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Moyamoya disease (MMD) is a rare and complex pathological condition characterized by an abnormal collateral circulation network in the basal brain. The diagnosis of MMD and its progression is unpredictable and influenced by many factors. MMD can affect the blood vessels supplying the eyes, resulting in a range of ocular symptoms. In this study, we developed a deep learning model using real-world data to assist a diagnosis and determine the stage of the disease using retinal photographs. METHODS This retrospective observational study conducted from August 2006 to March 2022 included 498 retinal photographs from 78 patients with MMD and 3835 photographs from 1649 healthy participants. Photographs were preprocessed, and an ResNeXt50 model was developed. Model performance was measured using receiver operating curves and their area under the receiver operating characteristic curve, accuracy, sensitivity, and F1-score. Heatmaps and progressive erasing plus progressive restoration were performed to validate the faithfulness. RESULTS Overall, 322 retinal photographs from 67 patients with MMD and 3752 retinal photographs from 1616 healthy participants were used to develop a screening and stage prediction model for MMD. The average age of the patients with MMD was 44.1 years, and the average follow-up time was 115 months. Stage 3 photographs were the most prevalent, followed by stages 4, 5, 2, 1, and 6 and healthy. The MMD screening model had an average area under the receiver operating characteristic curve of 94.6%, with 89.8% sensitivity and 90.4% specificity at the best cutoff point. MMD stage prediction models had an area under the receiver operating characteristic curve of 78% or higher, with stage 3 performing the best at 93.6%. Heatmap identified the vascular region of the fundus as important for prediction, and progressive erasing plus progressive restoration result shows an area under the receiver operating characteristic curve of 70% only with 50% of the important regions. CONCLUSIONS This study demonstrated that retinal photographs could be used as potential biomarkers for screening and staging of MMD and the disease stage could be classified by a deep learning algorithm.
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Affiliation(s)
- JaeSeong Hong
- Department of Biomedical Systems Informatics (J.H., Y.R.P.), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sangchul Yoon
- Department of Medical Humanities and Social Sciences (S.Y.), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyu Won Shim
- Department of Neurosurgery (K.W.S.), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yu Rang Park
- Department of Biomedical Systems Informatics (J.H., Y.R.P.), Yonsei University College of Medicine, Seoul, Republic of Korea
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Ashik R, Pal S, Patidar N, Gabba HS, Gaikwad H. Subconjunctival and Perioptic Vascular Lesion in Asymptomatic Moyamoya Disease - A Rare Ocular Presentation. Neurol India 2023; 71:802-803. [PMID: 37635531 DOI: 10.4103/0028-3886.383829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Affiliation(s)
- R Ashik
- Department of Orbit and Oculoplasty, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
| | - Sandeep Pal
- Department of Orbit and Oculoplasty, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
| | - Narendra Patidar
- Department of Orbit and Oculoplasty, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
| | - Harshdeep Singh Gabba
- Department of Orbit and Oculoplasty, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
| | - Himanshu Gaikwad
- Department of Orbit and Oculoplasty, Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India
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Alexis JA, Lock J, Kho L, Thompson AL, Prentice DA. Moyamoya-Like Vasculopathy and Orbital Trauma: An Association. Neuroophthalmology 2023; 47:262-268. [PMID: 38130810 PMCID: PMC10732633 DOI: 10.1080/01658107.2023.2212756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/30/2023] [Indexed: 12/23/2023] Open
Abstract
An Asian man in his 20s developed asymptomatic ipsilateral moyamoya-like vascular changes following orbital and head trauma. An ipsilateral traumatic optic neuropathy with extensive optic cupping ensued. The complex embryology of the ocular vascular development is reviewed as having a potential causative role in the intracranial carotid vasculopathy.
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Affiliation(s)
| | - Jane Lock
- Department of Ophthalmology, Royal Perth Hospital, Perth, Australia
- Department of Ophthalmology, Perth Children’s Hospital, Perth, Australia
- Department of Ophthalmology, Sir Charles Gairdner Hospital, Perth, Australia
| | - Lay Kho
- Department of Neurology, Royal Perth Hospital, Perth, Australia
- Department of Neurology, St. John of God Midland Hospital, Perth, Australia
| | - Andrew L. Thompson
- Neurological Intervention and Imaging Service of WA (NIISwa), Royal Perth and Sir Charles Gairdner Hospitals, Perth, Australia
| | - David A. Prentice
- Perron Institute for Neurological and Translational Science, Nedlands, Australia
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Karimaghaei S, Rook BS. When Pediatric Headaches Are Not Benign-Eye Findings. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020372. [PMID: 36832501 PMCID: PMC9955839 DOI: 10.3390/children10020372] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/02/2023] [Accepted: 02/07/2023] [Indexed: 02/16/2023]
Abstract
Headache is the most common neurologic complaint that presents to the pediatrician. While most headaches are benign in nature, patients must be carefully evaluated to rule out life- or vision-threatening causes. Non-benign etiologies of headache may exhibit ophthalmologic signs and symptoms that can help narrow the differential diagnosis. It is also important for physicians to know in what situations appropriate ophthalmologic evaluation is necessary, such as evaluating for papilledema in the setting of elevated intracranial pressure. In this article we discuss life- and/or vision-threatening etiologies of headache, including infection, autoimmune disease, cerebrovascular pathologies, hydrocephalus, intracranial neoplasia, and idiopathic intracranial hypertension, and their associated ophthalmologic manifestations. Due to less familiarity of the disease amongst primary care providers, we discuss pediatric idiopathic intracranial hypertension in more comprehensive detail.
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Affiliation(s)
- Sam Karimaghaei
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
- Department of Ophthalmology, Arkansas Children’s Hospital, Little Rock, AR 72202, USA
| | - Brita S. Rook
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
- Department of Ophthalmology, Arkansas Children’s Hospital, Little Rock, AR 72202, USA
- Correspondence:
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8
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Zou Y, She K, Hu Y, Ren J, Fei P, Xu Y, Peng J, Zhao P. Clinical and Echographic Features of Morning Glory Disc Anomaly in Children: A Retrospective Study of 249 Chinese Patients. Front Med (Lausanne) 2022; 8:800623. [PMID: 35141246 PMCID: PMC8818885 DOI: 10.3389/fmed.2021.800623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 12/10/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose To report the clinical and echographic features, the prevalence of retinal detachment (RD), and associated visual acuity in a cohort of pediatric patients with morning glory disc anomaly (MGDA). Methods This was a retrospective review of 249 pediatric patients with MGDA (271 eyes) seen at the Dept. of Ophthalmology, Xinhua Hospital. Their medical records were reviewed for demographic data and ocular and systemic findings. The maximal depth and width of the cavity were measured using standardized echographic images. The ratios of cavitary depth to axial length, cavitary depth to maximal cavitary width, and the product of cavitary depth and width were calculated and used to indicate the relative size of the excavation. The clinical and echographic findings were correlated with visual acuity and the occurrence of RD of the patient. Results The relative size of the excavation and the presence of RD were positively associated with increased risk of poor vision (p < 0.05). The presence of persistent fetal vasculature was not associated with the risk of RD and poor vision. The ratio of cavitary depth to axial length more than or equal to 0.25 conferred an increased risk of RD (OR, 2.101; 95% CI, 1.469–3.003). Conclusions Clinical and echographic features of MGDA may be used in predicting the risk of RD. Measuring the relative size of excavation via echography may guide the follow-ups and assist in the early diagnosis of RD.
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Affiliation(s)
- Yihua Zou
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kaiqin She
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Yiqian Hu
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianing Ren
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ping Fei
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Xu
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Peng
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Jie Peng
| | - Peiquan Zhao
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Peiquan Zhao
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Khan HM, Lo J, Sarunic MV, Gooderham PA, Yip S, Sheldon CA, Wirth MA. Quantitative Optical Coherence Tomography Angiography in Patients with Moyamoya Vasculopathy: A Pilot Study. Neuroophthalmology 2021; 45:386-390. [PMID: 34720269 DOI: 10.1080/01658107.2021.1959619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Moyamoya (MM) disease is a chronic cerebrovascular disease that can lead to progressive stenosis of the terminal portions of the internal carotid arteries and their proximal branches. We sought to investigate and quantify retinal vascular changes in patients with MM vasculopathy (MMV) using optical coherence tomography angiography (OCTA) compared to healthy controls. Our findings reveal retinal microvascular changes in patients with MMV and highlights the potential of OCTA imaging for the detection of subclinical retinal pathology.
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Affiliation(s)
- Haaris M Khan
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Julian Lo
- School of Engineering Science, Simon Fraser University, Burnaby, Canada
| | - Marinko V Sarunic
- School of Engineering Science, Simon Fraser University, Burnaby, Canada
| | - Peter A Gooderham
- Department of Neurosurgery, University of British Columbia, Vancouver, Canada
| | - Samuel Yip
- Department of Neurology, University of British Columbia, University of British Columbia, Koerner Pavilion, UBC Hospital, Vancouver, Canada
| | - Claire A Sheldon
- Department of Ophthalmology & Visual Sciences, University of British Columbia, Vancouver, Canada
| | - Magdalena A Wirth
- Department of Ophthalmology & Visual Sciences, University of British Columbia, Vancouver, Canada.,Department of Ophthalmology, University Hospital Zurich, Zürich, Switzerland
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Dupessey F, Sauvan L, Denis D. [Idiopathic elevated episcleral venous pressure in a patient with Moyamoya disease]. J Fr Ophtalmol 2021; 44:e397-e398. [PMID: 33892981 DOI: 10.1016/j.jfo.2020.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 11/24/2022]
Affiliation(s)
- F Dupessey
- Service d'ophtalmologie, CHU Nord, chemin des Bourrely, 13015 Marseille, France.
| | - L Sauvan
- Service d'ophtalmologie, CHU Nord, chemin des Bourrely, 13015 Marseille, France
| | - D Denis
- Service d'ophtalmologie, CHU Nord, chemin des Bourrely, 13015 Marseille, France
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Singh A, Panyala R, Mahesh M, Samanta R. An unusual association of Morning Glory Syndrome with chronic myeloid leukemia-Philadelphia chromosome. J Family Med Prim Care 2020; 9:4456-4459. [PMID: 33110885 PMCID: PMC7586549 DOI: 10.4103/jfmpc.jfmpc_892_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/14/2020] [Accepted: 06/19/2020] [Indexed: 11/20/2022] Open
Abstract
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.
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