1
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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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2
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Caporossi T, Ferrara S, Savastano A, Gambini G, De Vico U, Savastano MC, Rizzo S. MANAGEMENT OF RETINAL DETACHMENT ASSOCIATED WITH MORNING GLORY SYNDROME USING THE HUMAN AMNIOTIC MEMBRANE. Retin Cases Brief Rep 2024; 18:18-23. [PMID: 35944558 DOI: 10.1097/icb.0000000000001303] [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: 10/07/2021] [Accepted: 07/11/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE This case report describes an innovative procedure for addressing retinal detachment in patients with morning glory syndrome. METHODS An 18-year-old woman with unilateral morning glory syndrome complicated by macula-off retinal detachment without any visible peripheral retinal breaks underwent three corrective surgeries. In the first surgery, a 25-gauge pars plana vitrectomy with a 3-mm human amniotic membrane patch positioned on the optic disc and gas endotamponade was performed. When the gas reabsorbed, inferior retinal detachment recurred, and a second vitrectomy with silicone oil endotamponade was conducted. At three months, the retina was still attached under the silicone oil, so the oil was removed. At the second follow-up, retinal detachment had recurred, and a third vitrectomy with a larger amniotic patch and silicone oil endotamponade was performed. RESULTS Three months following the last surgery, the subretinal fluid had totally reabsorbed, and the retina was completely attached. The best-corrected visual acuity was 20/100. CONCLUSION To the best of our knowledge, the first description of a human amniotic patch associated with vitrectomy in morning glory syndrome complicated with retinal detachment is described. Using human amniotic membranes, positioned onto the optic nerve, and silicone oil endotamponade could be useful for morning glory syndrome complicated by retinal detachment.
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Affiliation(s)
- Tomaso Caporossi
- Department of Ophthalmology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy; and
| | - Silvia Ferrara
- Department of Ophthalmology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy; and
| | - Alfonso Savastano
- Department of Ophthalmology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gloria Gambini
- Department of Ophthalmology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Umberto De Vico
- Department of Ophthalmology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Cristina Savastano
- Department of Ophthalmology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy; and
| | - Stanislao Rizzo
- Department of Ophthalmology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy; and
- Consiglio Nazionale della Ricerca, Pisa, Italy
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3
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Ran H, Ren J, Li S, Han H, Liu H, Ai Z, Jiang K, Zhang J. Progression of bilateral morning glory syndrome associated with unilateral persistent fetal vasculture: A case report of long term follow-up in an infant. Eur J Ophthalmol 2023; 33:NP82-NP86. [PMID: 36788132 DOI: 10.1177/11206721231156493] [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: 02/16/2023]
Abstract
PURPOSE To describe a case of Bilateral Morning Glory Syndrome (MGS) associated with Unilateral Persistent Fetal Vasculature (PFV) in a 3-day old neonate. OBSERVATIONS A 3-day-old neonate was found bilateral retinal abnormalities due to neonatal eye screening. Dilated fundus exam showed bilateral optic disc dysplasia with the persistent hyaloid vessels in right eye at first. With the progress of the disease, optic disc was enlarged with central umbilication which with a similar anomalous radiating peripapillary vascular appearance, the persistent hyaloid vessels in vitreous cavity of right eye gradually disappear, a large amount of exudation can be seen in the posterior pole retina with macular movement in both eyes. Bilateral vitrectomy was performed in this case, then the condition of the neonate's both eyes is stable until 1 year old. CONCLUSIONS AND IMPORTANCE This is a rare case that showing the development of MGS and PFV and the relationship between these two diseases. In addition, we completely observed the whole process of the change of the persistent hyaloid vessels in the vitreous cavity of a case of MGS associated with PFV.
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Affiliation(s)
- Hongyun Ran
- Department of Ophthalmology, Chengdu Qingbaijiang District People's Hospital, No. 9, Fenghuang West Fourth Road, Qingbaijiang District, Chengdu, Sichuan, China
| | - Jiantao Ren
- Department of Ophthalmology, Weifang Eye Hospital, 139 Xingfu Road, Kuiwen District, Weifang, Shandong, China
| | - Shuchan Li
- Department of Ophthalmology, Weifang Eye Hospital, 139 Xingfu Road, Kuiwen District, Weifang, Shandong, China
| | - Haitao Han
- Department of Ophthalmology, Weifang Eye Hospital, 139 Xingfu Road, Kuiwen District, Weifang, Shandong, China
| | - Hangyu Liu
- Department of Ophthalmology, Weifang Eye Hospital, 139 Xingfu Road, Kuiwen District, Weifang, Shandong, China
| | - Zhaohui Ai
- Department of Ophthalmology, Weifang Eye Hospital, 139 Xingfu Road, Kuiwen District, Weifang, Shandong, China
| | - Keke Jiang
- Department of Ophthalmology, Weifang Eye Hospital, 139 Xingfu Road, Kuiwen District, Weifang, Shandong, China
| | - Jie Zhang
- Department of Ophthalmology, Weifang Eye Hospital, 139 Xingfu Road, Kuiwen District, Weifang, Shandong, China
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4
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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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5
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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: 0] [Impact Index Per Article: 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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Zou Y, Wang X, Li J, Peng J, Zhao P. Natural Course for Retinal Detachment in Morning Glory Disc Anomaly Based on a Grading System. Asia Pac J Ophthalmol (Phila) 2022; Publish Ahead of Print:S2162-0989(24)00024-0. [PMID: 36259146 DOI: 10.1097/apo.0000000000000572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/06/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Yihua Zou
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine Shanghai, China
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7
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Isjanovski I, Velkovska B. Morning Glory Syndrome- A case report. Arch Public Health 2022. [DOI: 10.3889/aph.2022.6048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Morning Glory Syndrome (MGS) is an uncommon congenital anomaly of the eye nerve (optic nerve) that resembles a flower known as morning glory, impairs vision, and may be associated with both ocular and non-ocular abnormalities. It has a characteristic fundoscopic appearance consisting of a large funnel-shaped cavity on the optical disc. We register an unusual congenital anomaly of the optic disc in a three-year-old female child.
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Sato T, Kuniyoshi K, Kodama T, Kusaka S. Recurrent proliferative vitreoretinopathy in a patient with morning glory syndrome and intellectual disability. Am J Ophthalmol Case Rep 2022; 26:101416. [PMID: 35243156 PMCID: PMC8857424 DOI: 10.1016/j.ajoc.2022.101416] [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: 05/05/2021] [Revised: 02/06/2022] [Accepted: 02/09/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose To report a case of morning glory syndrome (MGS) with retinal detachment, in whom unusually severe proliferative vitreoretinopathy (PVR) developed after surgery. Observations A 6-year-old boy with intellectual disability underwent vitrectomy for retinal detachment associated with MGS in the left eye. Vitrectomy was performed five times. C3F8 gas tamponade was used for the first and second surgeries. However, the retina developed PVR with a nearly 360-degree giant retinal tear after the second surgery. The third surgery required 360-degree retinotomy, followed by short-term perfluoro-n-octane (PFO) tamponade, which was removed ten days later. During the fourth surgery, the retina was found to be flipped over in a funnel-shape on the retinal pigment epithelium under the PFO. Silicone oil (SO) tamponade was used. During the fifth surgery, the retina was flipped over under the SO again. We found that the patient shook his head rapidly and vigorously while crying. Conclusions and importance We speculate that excessive head shaking associated with the patient's intellectual disability induced an unusual shape of the retina under PFO or SO. Although difficult to achieve, postoperative resting seems important in preventing such complications in intellectually disabled patients with retinal detachment. Severe proliferative vitreoretinopathy developed after surgery for retinal detachment associated with morning glory syndrome. The retina was flipped over under perfluorocarbon liquid or silicone oil. Such unusual complications may have occurred by the excessive head shaking associated with the patient's intellectual disability.
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9
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Shen J, Chen X, Gong X, Wu Z. Internal limiting membrane packing for treatment of morning glory syndrome with rhegmatogenous retinal detachment. Am J Ophthalmol Case Rep 2022; 26:101454. [PMID: 35265775 PMCID: PMC8899239 DOI: 10.1016/j.ajoc.2022.101454] [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: 11/29/2021] [Revised: 02/10/2022] [Accepted: 02/22/2022] [Indexed: 12/01/2022] Open
Abstract
Purpose Observations Conclusions and importance Morning Glory syndrome (MGS) is a rare congenital optic disc abnormality. We report a case of MGS combined with rhegmatogenous retinal detachment (RRD) in which the contractile movement of the retinal hole was observed. This case is the first to report the successful treatment of a retinal hole in a MGS patient by internal limiting membrane tamponade combined with autologous blood coverage.
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10
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Soliman SE, Wan MJ, Pennal A, Pope E, Mireskandari K. Ophthalmic involvement in PHACES syndrome: prevalence, spectrum of anomalies, and outcomes. J AAPOS 2022; 26:129.e1-129.e7. [PMID: 35550864 DOI: 10.1016/j.jaapos.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 12/13/2021] [Accepted: 01/09/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE To highlight prevalence, spectrum of anomalies, and outcome of ophthalmic involvement in PHACES syndrome (posterior fossa malformations, infantile hemangiomas, arterial, cardiac, eye, and sternal anomalies). METHODS A retrospective, noncomparative, single-institution observational case series of children with PHACES was conducted from 2000 to 2019. Data on ocular presentations, interventions and visual outcomes were collected. Primary outcome measures were the frequency and spectrum of ocular involvement. Secondary outcomes were final visual acuity, long-term ocular sequelae, and frequency of surgical interventions. RESULTS A total of 43 infants had PHACES, of whom 29 (67%) had periocular infantile facial hemangiomas (IFH) and 6 (14%) had primary ocular anomalies that were always ipsilateral to the IFH. Five patients (12%) met ocular PHACES-specific diagnostic criteria, including optic nerve (3), retinal vascular (1) and lenticular (2) anomalies. Non-PHACES-specific abnormalities were Peters anomaly (1), persistent pupillary membranes (2), dysmorphic optic nerves (1), and iris/choroidal hemangiomas (2). IFH-related periocular abnormalities were frequent: ptosis (29), proptosis (9), strabismus (6). Surgery was required in 8 of the 29 children: (strabismus [6], entropion [2], ptosis [2], and optical iridectomy [1]), all of whom had orbital/conjunctival hemangioma (P = 0.03). Final visual acuity (follow-up, 8.7 years) ranged between 20/20 and 20/80 in 26 of 29 patients. All patients with visual acuity worse than 20/200 (3/29 [10%]) had structural anomalies. CONCLUSIONS Two-thirds of infants with PHACES have periocular IFH causing vision compromising complications of amblyopia and strabismus. Structural ocular anomalies exist in 1 of 7 patients and are always ipsilateral to the IFH. Long-term ophthalmic monitoring and management is required, and the majority of patients obtain good visual outcomes.
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Affiliation(s)
- Sameh E Soliman
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada; Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Michael J Wan
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Alexandra Pennal
- Section of Dermatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Elena Pope
- Section of Dermatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Kamiar Mireskandari
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada.
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11
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Orman G, Aydınoglu-Candan O, Sungur G. The prevalance of congenital optic disc anomalies in Turkey: a hospital-based study. Int Ophthalmol 2022; 42:3567-3577. [PMID: 35536457 DOI: 10.1007/s10792-022-02357-8] [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: 12/02/2021] [Accepted: 04/18/2022] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- Gozde Orman
- Health Science Univercity Ankara Researching and Training Hospital, Departmant of Ophthalmolgy, Ankara, Turkey.
| | - Ozlem Aydınoglu-Candan
- Health Science Univercity Ankara Researching and Training Hospital, Departmant of Ophthalmolgy, Ankara, Turkey
| | - Gulten Sungur
- Health Science Univercity Ankara Researching and Training Hospital, Departmant of Ophthalmolgy, Ankara, Turkey
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12
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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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13
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Optic Nerve Abnormalities in Morning Glory Disc Anomaly: An MRI Study. J Neuroophthalmol 2021; 42:199-202. [PMID: 34812761 DOI: 10.1097/wno.0000000000001412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The morning glory disc anomaly (MGDA) is a rare congenital malformation of the optic disc. The association with a significant enlargement of the optic nerve has been recently reported in a few cases, raising the question of potentially associated optic nerve gliomas. The objective was to report the anatomy of optic nerves on MRI in patients with MGDA. METHODS In this retrospective single-center study, files of patients with a clinical diagnosis of MGDA were identified through a rare disease database (CEMARA) and included. We reviewed every cerebral and orbital MRI available, performed between 2008 and 2018. Anatomy of the optic nerve from the optic disc to the chiasm was evaluated on MRI. RESULTS Nine patients were included. All presented unilateral MGDA. Age at first MRI was 0.6-62 years, median = 3.8 years. MRI showed posterior protrusion of the globe (staphyloma) centered by the optic disc in all cases (100%). Ipsilateral optic nerve abnormalities were found in all cases (100%). The optic nerve was found thinner than the contralateral one in its intraorbital, intracanalar, and intracranial portions in 1 case (11%); in 8 cases (89%), the thickness of the optic nerve was irregular and varied along its pathway: thick, normal, and/or thin. When gadolinium injection had been performed (3 cases), none exhibited gadolinium enhancement. When serial MRI scanning was available (4 cases), there was no evolution of the abnormalities. CONCLUSION In patients with MGDA, optic nerve and chiasm abnormalities are the rule, with most often a unique pattern of irregular optic nerve thickness-hypertrophy and hypoplasia-from the orbit to the chiasm. Such pattern should be recognized and points to a developmental abnormality, rather than an optic nerve glioma.
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Abstract
Optical coherence tomography (OCT) is widely applied in diagnosis and management of retina diseases particularly macular diseases in adult retina practices. However, it has been under-utilized in pediatric retinal diseases especially in neonates and infants. Utilization of OCT in primary macular diseases in this age group is also uncommon and is less reported. Challenges involved in image acquisition and limitations with available devices technique can explain the limited research and accurate data availability in the literature in this field. Purpose of this review article is to summarize the use of OCT and its importance in various infantile retinal pathologies such as vascular diseases, tumors, retinal dystrophies, and optic nerve pathologies with primary focus on neonates and infants, along with infant choroid. In addition, we also discuss about future directions including OCT angiography for infants.
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Affiliation(s)
- Sushma Jayanna
- Consultant Ophthalmologist, Department of Srimathi Kannuri Santhamma Center of Vitreoretinal Eye Disease, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Subhadra Jalali
- Consultant Ophthalmologist, Department of Srimathi Kannuri Santhamma Center of Vitreoretinal Eye Disease, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Tapas R Padhi
- Consultant Ophthalmologist, Department of Retina and Vitreous, Mithu Tulasi Chanrai Campus, Bhubaneswar, LV Prasad Eye Institute, India
| | - Komal Agarwal
- Consultant Ophthalmologist, Department of Srimathi Kannuri Santhamma Center of Vitreoretinal Eye Disease, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Jay Chhablani
- University of Pittsburgh, UPMC Eye Center, Pittsburgh, PA, USA
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15
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Ramirez-Estudillo A, Torres-Navarro K, Rojas-Juárez S, Ramirez-Galicia X, Palafox-Cornejo B, Galicia-Castillo A. Case Report: Fibroglial Retinal Tissue in Contractile Morning Glory Disc Anomaly. Case Rep Ophthalmol 2021; 12:525-530. [PMID: 34248586 PMCID: PMC8255660 DOI: 10.1159/000510958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 08/18/2020] [Indexed: 11/19/2022] Open
Abstract
The purpose of the present case is to describe a patient with tractional retinal detachment (RD) associated with contractile morning glory: a 17-year-old female, with a history of failed surgery for RD when she was 2 years old in her right eye (OD), nystagmus, and a limited visual acuity in the left eye (OS). The slit lamp examination showed phthisis bulbi in OD and the anterior segment was unremarkable in OS. Dilated fundus examination revealed a tractional RD in the posterior pole and peripapillary and preretinal fibrosis without evidence of intravitreal dispersion of retinal pigment epithelial cells. After surgery treatment, the RD resolved and the posterior segment showed a staphylomatous excavation around the optic disc anomaly with irregular contractions that folded the macular area. This were unrelated to light, breathing, or eye movements. Although morning glory disc anomaly is associated with RD, the early diagnosis can reverse structural changes. In this case, the rare association with contractile movements was found posterior to the pars plana vitrectomy after all the fibroglial epiretinal tissue was removed.
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Affiliation(s)
- Abel Ramirez-Estudillo
- Retina Division, Ophthalmology Department, Hospital de la Luz I.A.P., Ciudad de México, México
| | - Karla Torres-Navarro
- Retina Division, Ophthalmology Department, Hospital de la Luz I.A.P., Ciudad de México, México
| | - Sergio Rojas-Juárez
- Retina Division, Ophthalmology Department, Hospital de la Luz I.A.P., Ciudad de México, México
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Kumar J, Adenuga OO, Singh K, Ahuja AA, Kannan NB, Ramasamy K. Clinical characteristics of morning glory disc anomaly in South India. Taiwan J Ophthalmol 2021; 11:57-63. [PMID: 33767956 PMCID: PMC7971437 DOI: 10.4103/tjo.tjo_52_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/21/2020] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Jayant Kumar
- Department of Vitreo- Retina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Olukorede O Adenuga
- Department of Ophthalmology, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Kritika Singh
- Department of Vitreo- Retina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Ashish A Ahuja
- Retina Unit, Sadhu Kamal Eye Hospital, Mumbai Central, Maharashtra, India
| | - Naresh B Kannan
- Department of Vitreo- Retina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Kim Ramasamy
- Department of Vitreo- Retina Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
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17
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Trifonova K, Slaveykov K. Morning Glory Disc Anomaly with Contractile Peripapillary Staphyloma in an 18-Month-Old Girl. Neuroophthalmology 2021; 45:36-40. [PMID: 33762786 DOI: 10.1080/01658107.2020.1773507] [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: 10/23/2022] Open
Abstract
We present an 18-month-old girl with strabismus and a variable esotropia of the left eye. Fixation of the affected eye was intermittent with a relative afferent pupillary defect. A fundus photography of the left eye displayed a combination of features of both morning glory disc anomaly and peripapillary staphyloma. A B-scan ultrasonography examination of the left eye showed a conical excavation of the posterior pole. Cycloplegic refraction measurements showed a large amount of anisometropia. Correction with glasses and part-time occlusion was prescribed and a strict follow-up routine was advised. No other systemic associations with the disease have been discovered so far in our patient. We support the theory that morning glory disc anomaly and peripapillary staphyloma may represent two different morphologies in the spectrum of the same disease.
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Affiliation(s)
- Kalina Trifonova
- Department of Ophthalmology and Otorhinolaryngology, Trakia University, Stara Zagora, Bulgaria
| | - Kiril Slaveykov
- I-st Department of Internal Disease and General Medicine, Trakia University, Stara Zagora, Bulgaria
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18
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Hwang I, Ugarte M. Morning glory disc anomaly-associated maculopathy: multimodal imaging. BMJ Case Rep 2021; 14:14/1/e237462. [PMID: 33462012 PMCID: PMC7813365 DOI: 10.1136/bcr-2020-237462] [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: 01/21/2023] Open
Abstract
Morning glory disc anomaly (MGDA) is most commonly found in white females in childhood with reduced vision. One in two cases have been reported to develop maculopathy or posterior pole retinal detachment as they grow older. The pathophysiology of MGDA-associated maculopathy is not well understood.We describe a 31-year-old black woman, who presented with gradual reduction of vision in the right eye due to MGDA-associated maculopathy. We identified morphological characteristics of the optic disc and macula with multicolour and optical coherence tomography imaging.We speculate that the centripetal inner retina traction and cerebrospinal fluid pressure fluctuation play an important role in inner retinal fluid accumulation in the pathology of retinoschisis in MGDA. Further studies will shed some light of a potential cause-and-effect relationship between MGDA and retinoschisis.
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Affiliation(s)
- Inae Hwang
- The University of Manchester, Faculty of Biology, Medicine and Health, Manchester, Greater Manchester, UK
| | - Marta Ugarte
- The University of Manchester, Faculty of Biology, Medicine and Health, Manchester, Greater Manchester, UK,Manchester University NHS Foundation Trust, Manchester Royal Eye Hospital, Manchester, UK
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19
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Total retinal detachment and contractile movement of the disc in eyes with morning glory syndrome. Am J Ophthalmol Case Rep 2020; 20:100964. [PMID: 33117915 PMCID: PMC7581832 DOI: 10.1016/j.ajoc.2020.100964] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/15/2020] [Accepted: 10/04/2020] [Indexed: 12/23/2022] Open
Abstract
Purpose This study aimed to report clinical characteristics, intraoperative findings, and surgical outcomes of 2 eyes of 2 patients with retinal detachment (RD) associated with morning glory syndrome (MGS) and contractile movement of the disc. Observations Case 1 was a 3-year-old Japanese boy who presented with congenital microphthalmos in the left eye. The presence of total RD with MGS and contractile movement of the disc was confirmed by ophthalmoscopic examination. During vitrectomy, migration of perfluorocarbon liquid into the subretinal space was observed, suggesting a communication between the vitreous cavity and the subretinal space. Here, the retina was reattached briefly after the surgery; however, it detached again 2 months after surgery. Case 2 was a 3-month-old Japanese girl who was referred to our hospital for evaluation of RD and MGS in her left eye. Partial RD, MGS, and contractile movement of the disc were confirmed by ophthalmoscopic examination. The RD remained unchanged up to 18 months from the first visit, but atresia of the pupil was found 21 months after the first visit. Severe proliferative vitreoretinopathy and contractile movement of the disc were found after lensectomy. It was impossible to completely remove the membrane despite meticulous effort of peeling it off. At the 15-month follow-up, the retinal configuration improved but remained detached. Conclusion and importance Total RD with contractile movement of the disc associated with MGS is a rare condition that seems difficult to treat.
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20
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Muns SM, González MP, Villegas VM, de la Vega G, Ventura CV, Berrocal AM. Unilateral morning glory disc anomaly in a patient with prenatal Zika virus exposure. Int J Retina Vitreous 2020; 6:36. [PMID: 32765899 PMCID: PMC7395399 DOI: 10.1186/s40942-020-00240-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/25/2020] [Indexed: 11/21/2022] Open
Abstract
Background To report a case of morning glory disc anomaly (MGDA) in a pediatric patient with prenatal Zika virus (ZIKV) exposure. Case presentation A 3-year-old male with prenatal exposure to ZIKV, confirmed by real-time polymerase chain reaction testing during the second trimester of pregnancy, was evaluated due to visual loss. Physical examination was remarkable for unilateral MGDA. Neuroimaging showed a base of skull encephalocele through the floor of the sella and callosal dysgenesis. Conclusions This is the first report to suggest an association between prenatal ZIKV exposure and MGDA. Prenatal ZIKV exposure may be associated to a wider pathologic spectrum than previously reported.
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Affiliation(s)
- Sofía M Muns
- Department of Ophthalmology, University of Puerto Rico, Medical Sciences Campus, San Juan, PR 00936-5067 USA
| | - Mónica P González
- Department of Ophthalmology, University of Puerto Rico, Medical Sciences Campus, San Juan, PR 00936-5067 USA
| | - Victor M Villegas
- Department of Ophthalmology, University of Puerto Rico, Medical Sciences Campus, San Juan, PR 00936-5067 USA.,Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136 USA.,Department of Surgery, Ponce Health Sciences University, Ponce, PR 00732-7004 USA
| | | | - Camila V Ventura
- Department of Ophthalmology, Altino Ventura Foundation, Recife, Brazil.,Department of Ophthalmology, HOPE Eye Hospital, Recife, Brazil
| | - Audina M Berrocal
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136 USA
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21
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Sevgi DD, Orge FH. Contractile morning glory disk anomaly: analysis of the cyclic contractions and literature review. J AAPOS 2020; 24:99.e1-99.e6. [PMID: 32224283 DOI: 10.1016/j.jaapos.2020.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 01/23/2020] [Accepted: 01/25/2020] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Duriye Damla Sevgi
- University Hospitals Cleveland Medical Center, Rainbow Babies & Children's Hospital, Cleveland, Ohio
| | - Faruk H Orge
- University Hospitals Cleveland Medical Center, Rainbow Babies & Children's Hospital, Cleveland, Ohio.
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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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23
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Case Report: Optical Coherence Tomography Angiography in Morning Glory Disc Anomaly. Optom Vis Sci 2019; 95:550-552. [PMID: 29787489 DOI: 10.1097/opx.0000000000001225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SIGNIFICANCE Morning glory disc anomaly is a congenital abnormality of the optic disc. Optical coherence tomography angiography shows vascular rarefaction of the superficial and deep capillary plexuses and increased vascularity of the radial peripapillary capillary plexus. We hypothesize that this congestion represents a compensatory mechanism to an abnormal vasculogenesis. PURPOSE The aim of this study was to describe the optic disc vascular alterations occurring at choriocapillaris and retinal vascular plexuses in a patient affected by bilateral morning glory disc anomaly with optical coherence tomography angiography. CASE REPORT A 24-year-old white man presented for clinical evaluation to our Department of Ophthalmology (San Raffaele Hospital, Milan) complaining of reduced vision in his left eye. Whereas his right eye was unremarkable (20/20), the visual acuity in the left one was limited to 20/30 Snellen equivalent. Funduscopic examination revealed bilateral funnel-shaped optic disc excavation, with a central mass of glial tissue and straight retinal vessels radially emerging from the disc margin, more evident in the left eye; this presentation was considered compatible with bilateral morning glory disc anomaly. Optical coherence tomography angiography of the optic disc disclosed prominent vascular rarefaction of the peripapillary superficial and deep capillary plexuses and choriocapillaris, with an increased vascularity of the radial peripapillary capillary network. CONCLUSIONS Based on these observations, we hypothesize that the congestion of the radial peripapillary capillary plexus might be a compensatory mechanism to the abnormal vasculogenesis occurring in the optic disc of patients affected by morning glory disc anomaly.
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24
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Skriapa Manta A, Olsson M, Ek U, Wickström R, Teär Fahnehjelm K. Optic Disc Coloboma in children - prevalence, clinical characteristics and associated morbidity. Acta Ophthalmol 2019; 97:478-485. [PMID: 30549247 DOI: 10.1111/aos.13999] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 11/16/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of the study was to report prevalence, ocular outcome, neurological characteristics, cognitive and behavioural problems in children with optic disc coloboma (ODC). METHODS This was a population-based, cross-sectional study of 31 children between 2 and 18 years of age diagnosed with ODC. The children were part of a larger cohort of 184 children with congenital optic disc malformations. Clinical ophthalmological examinations, neurological assessments, behavioural and developmental screening were performed. RESULTS The prevalence of ODC was 8.9/100 000 children. Of the 31 patients, 18 had unilateral ODC (p = 0.21). The best-corrected visual acuity (BCVA) in the ODC eye ranged from blindness to 1.3 (median 0.3). BCVA was 0.82 in eyes with an isolated ODC (range 0.4-1.3) and 0.15 (range 0-0.5) in eyes with concurrent macular involvement (p < 0.0001). Nystagmus was observed more often in patients with bilateral ODC (9/13 versus 3/17, p = 0.004). Two patients had retinal detachment. Behavioural/psychological screening was performed in 21 patients with severe deficits identified in six cases. Intellectual disability was present in seven patients. Neurological dysfunction was diagnosed in 8/22 cases. All of the above children had already systemic diagnoses before the ODC diagnosis was made. CONCLUSIONS ODC was the second most common optic disc malformation in this cohort after optic nerve hypoplasia. The children had a wide range of ocular comorbidity. An isolated ODC without macular involvement was not associated with profound vision loss. The ability of screening in the regular child care centres to diagnose extraocular comorbidities was very good and referral to a paediatrician appears redundant in cases of normal development.
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Affiliation(s)
- Athanasia Skriapa Manta
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
- Department of Paediatric Ophthalmology and Strabismus St. Erik Eye Hospital Stockholm Sweden
| | - Monica Olsson
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
- Department of Paediatric Ophthalmology and Strabismus St. Erik Eye Hospital Stockholm Sweden
| | - Ulla Ek
- Department of Special Education Stockholm University Stockholm Sweden
| | - Ronny Wickström
- Neuropaediatric Unit Department of Women's and Children's Health Karolinska Institutet Stockholm Sweden
| | - Kristina Teär Fahnehjelm
- Department of Clinical Neuroscience Karolinska Institutet Stockholm Sweden
- Department of Paediatric Ophthalmology and Strabismus St. Erik Eye Hospital Stockholm Sweden
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Koerner JC, Sweeney J, Rheeman C, Kenning TJ. Delayed presentation of morning glory disc anomaly and transsphenoidal encephalocele: A management dilemma. Neuroophthalmology 2019; 43:95-101. [PMID: 31312233 DOI: 10.1080/01658107.2018.1479434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 05/07/2018] [Accepted: 05/17/2018] [Indexed: 01/02/2023] Open
Abstract
Background Morning glory disc anomaly (MGDA) is a rare developmental abnormality of the optic disc that is associated with many other neurological and vascular conditions. Most cases are diagnosed in childhood. Case Report We report a 57-year-old woman who presented to the ophthalmology department for assessment of long-standing poor vision in the left eye and exotropia. Examination showed a left MGDA and bitemporal hemianopsia. These findings prompted magnetic resonance imaging, revealing a transsphenoidal basal meningoencephalocele with herniation of the optic chiasm and inferior hypothalamus into the dural sac. Due to the eloquence of the neurovascular structures it contained, a decision was made not to reduce the meningoencephalocele. Instead, a ventriculoperitoneal shunt was placed. The patient's ophthalmologic examination remained stable over the following year. Conclusion While rare, MGDA can be first diagnosed in late adulthood and a thorough evaluation should be completed to assess for midline cranial defects, vascular abnormalities, and other associated abnormalities. Patients presenting late in life with basal encephalocele, herniation of the optic chiasm, and bitemporal hemianopsia present a management dilemma. In this case, a ventriculoperitoneal shunt was placed with the intention of lowering intracranial pressure to prevent further herniation and reduce the risk of cerebrospinal fluid leak.
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Affiliation(s)
- Jagger C Koerner
- Department of Ophthalmology, Albany Medical Center, Albany, NY, USA
| | - Jared Sweeney
- Department of ophthalmology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Charles Rheeman
- Department of Ophthalmology, Albany Medical Center, Albany, NY, USA
| | - Tyler J Kenning
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
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Jiang H, Liang Y, Long K, Luo J. Postoperative follow-up of a case of atypical morning glory syndrome associated with persistent fetal vasculature. BMC Ophthalmol 2019; 19:150. [PMID: 31311513 PMCID: PMC6636068 DOI: 10.1186/s12886-019-1154-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 06/27/2019] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Heng Jiang
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Rd, Changsha, Hunan, 410011, People's Republic of China.,Hunan Clinical Research Center of Ophthalmic Disease, Changsha, Hunan, 410011, People's Republic of China
| | - Youling Liang
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Rd, Changsha, Hunan, 410011, People's Republic of China.,Hunan Clinical Research Center of Ophthalmic Disease, Changsha, Hunan, 410011, People's Republic of China
| | - Kejun Long
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Rd, Changsha, Hunan, 410011, People's Republic of China.,Hunan Clinical Research Center of Ophthalmic Disease, Changsha, Hunan, 410011, People's Republic of China
| | - Jing Luo
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Rd, Changsha, Hunan, 410011, People's Republic of China. .,Hunan Clinical Research Center of Ophthalmic Disease, Changsha, Hunan, 410011, People's Republic of China.
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Alshamrani AA, Alghulaydhawi FA, Al Shamrani M. Marcus Gunn Jaw-Winking Syndrome Associated with Morning Glory Disc Anomaly. Middle East Afr J Ophthalmol 2019; 26:37-39. [PMID: 31114123 PMCID: PMC6507382 DOI: 10.4103/meajo.meajo_279_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Marcus Gunn jaw-winking syndrome (MGJWS) is a rare form of congenital blepharoptosis and one of the congenital cranial dysinnervation disorders (CCDD). In addition, morning glory disc anomaly (MGDA) is a congenital optic disc anomaly of unknown etiology. The present report is the first to describe an association between MGJWS and MGDA in an otherwise healthy 7-year-old boy. He also had counting finger vision, anisometropia, esotropia, and monocular elevation deficiency in the same eye. In the literature, both MGJWS and MGDA have been reported to be associated with Duane retraction syndrome, a form of CCDD.
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Affiliation(s)
| | - Fahad A Alghulaydhawi
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,Department of Ophthalmology, College of Medicine, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
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28
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Abdelkader E, AlHilali S, Neuhaus C, Bergmann C, AlMurshed T, Schatz P. Congenital stationary night blindness associated with morning glory disc malformation: a novel hemizygous mutation in CACNA1F. Ophthalmic Genet 2018; 39:659-661. [PMID: 30067413 DOI: 10.1080/13816810.2018.1498526] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Ehab Abdelkader
- a Vitreoretinal Division , King Khaled Eye Specialist Hospital , Riyadh , Saudi Arabia
| | - Sara AlHilali
- a Vitreoretinal Division , King Khaled Eye Specialist Hospital , Riyadh , Saudi Arabia
| | | | | | - Tahani AlMurshed
- a Vitreoretinal Division , King Khaled Eye Specialist Hospital , Riyadh , Saudi Arabia
| | - Patrik Schatz
- a Vitreoretinal Division , King Khaled Eye Specialist Hospital , Riyadh , Saudi Arabia
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A Rare Case of Unilateral Morning Glory Disc Anomaly in a Patient with Turner Syndrome: Report and Review of Posterior Segment Associations. Case Rep Ophthalmol Med 2018; 2018:5969157. [PMID: 30050712 PMCID: PMC6046149 DOI: 10.1155/2018/5969157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/23/2018] [Accepted: 06/03/2018] [Indexed: 11/18/2022] Open
Abstract
Turner syndrome is a common sex chromosome disorder affecting females. The disorder is caused by a partial loss, complete absence, or structural abnormality of one X chromosome. The clinical presentation is broad and ranges from the classic phenotype to minimal clinical manifestations. Ocular abnormalities associated with the syndrome are common. Reports describing abnormal eye features in individuals with Turner syndrome generally involve refractive errors (myopia or hyperopia), strabismus, and external or anterior segment abnormalities including hypertelorism, epicanthal folds, and ptosis. Posterior ocular segment anomalies involving the optic nerve and retina in Turner syndrome have been rarely reported. We report a rare presentation of an 11-year-old female with Turner syndrome and unilateral morning glory disc anomaly.
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30
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Cao XS, Peng XY, You QS, Jiang LB, Jonas JB. CONGENITAL CONTRACTILE PERIPAPILLARY STAPHYLOMA WITH RHEGMATOGENOUS RETINAL DETACHMENT. Retin Cases Brief Rep 2018; 12:48-49. [PMID: 27668502 DOI: 10.1097/icb.0000000000000412] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE To describe the occurrence of a congenital contractile peripapillary staphyloma in association with a rhegmatogenous retinal detachment. METHODS The clinical course of a 17-year-old patient with a contractile peripapillary staphyloma and undergoing pars plana vitrectomy for repair of an associated retinal detachment was studied. RESULTS The left eye showed a peripapillary staphyloma which during the ophthalmoscopical examination revealed contractile movements after the presentation of a light stimulus to either eye. The contraction of the peripapillary staphyloma was not correlated with a Valsalva maneuver, neck venous compression, forced lid closure, or respiratory movements. Because of a retinal detachment involving the inferior, nasal, and temporal retina, best-corrected visual acuity was 20/100. During pars plana vitrectomy under systemic anesthesia, the contractions of the peripapillary staphyloma subsided in the early phase of surgery, and reoccurred at approximately 80 minutes after the start of general anesthesia, when the posterior pole was touched with an aspiration syringe. CONCLUSION The etiology of the movements of the congenital peripapillary staphyloma in our patient may include a misbalance between intraocular pressure and orbital cerebrospinal fluid pressure or contractions of extraocular muscles. The observations may give information about the physiology and pathophysiology of the optic nerve head.
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Affiliation(s)
- Xu Sheng Cao
- Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
| | - Xiao Yan Peng
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
| | - Qi Sheng You
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
| | - Li Bin Jiang
- Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
| | - Jost B Jonas
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Lab, Beijing, China
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University Heidelberg, Seegartenklinik Heidelberg, Germany
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Congenital anomalies of the optic disc: insights from optical coherence tomography imaging. Curr Opin Ophthalmol 2017; 28:579-586. [PMID: 28817389 DOI: 10.1097/icu.0000000000000425] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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Lytvynchuk LM, Glittenberg CG, Ansari-Shahrezaei S, Binder S. Intraoperative optical coherence tomography assisted analysis of pars Plana vitrectomy for retinal detachment in morning glory syndrome: a case report. BMC Ophthalmol 2017; 17:134. [PMID: 28764684 PMCID: PMC5540621 DOI: 10.1186/s12886-017-0533-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 07/25/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The pathogenesis of non-rhegmatogenous retinal detachment (non-RRD) associated with morning glory syndrome (MGS) is not established, as well as best surgical approach to treat RD. Our purpose was to analyse intraoperative optical coherence tomography data (iOCT) in all steps of pars plana vitrectomy (PPV) for non-RRD in MGS, in order to follow pathophysiological aspects of the disease and to understand the tissues behaviour during surgical workflow. CASE PRESENTATION Intraoperative spectral domain optical coherent tomography (iSD-OCT) assisted PPV using Rescan 700 (Carl Zeiss Meditech, Jena, Germany) with epiretinal membrane (ERM) and internal retinal membrane (ILM) peeling, and air endotamponade was performed on the only eye of a 21 years old female with non-RRD associated with MGS. BCVA, pre-, intra- and postoperative OCT were performed along with standard ocular examination. iOCT video and snapshots were analysed intra- and postoperatively using post-processing approach using graphic software. The progression of non-RRD resulted in best corrected visual acuity (BCVA) decrease from 0.8 to 0.2. Triamcinolone enhanced iOCT imaging revealed strong vitreous traction and adhesion above the macula and optic disc. Internal limiting membrane was peeled under iOCT control to prevent the peeling of inner layers of the retinal schisis. No retinal break was detected, and only air endotamponade was performed. The retina reattached during first 4 weeks of follow-up with gradual resolution of intraretinal- and subretinal fluid, and remained stable in 12 months. BCVA improved to 0.8. CONCLUSION Based on iSD-OCT findings we assume that non-RRD in this case of MGS is caused primarily by the vitreous traction with further possible formation of the retinal breaks. Retinal reattachment reached only with air endotamponade strongly advocates the tractional component of non-RRD and retinal schisis assotiated with MGS. Early PPV for central non-RRD and retinal schisis with the use of iOCT can be performed in more safe and controlled manner and has to be considered to reduce the risk of retinal break formation and to prevent the central vision loss.
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Affiliation(s)
- Lyubomyr M Lytvynchuk
- Department of Ophthalmology, Justus-Liebig-University Giessen, Eye Clinic, University Hospital Giessen and Marburg GmbH, Campus Giessen, Friedrichstrasse 18, 35392, Giessen, Germany. .,Karl Landsteiner Institute for Retinal Research and Imaging, Juchgasse 25, A-1030, Vienna, Austria.
| | - Carl G Glittenberg
- Department of Ophthalmology, Rudolf Foundation Clinic, Juchgasse 25, A-1030, Vienna, Austria.,Karl Landsteiner Institute for Retinal Research and Imaging, Juchgasse 25, A-1030, Vienna, Austria
| | - Siamak Ansari-Shahrezaei
- Department of Ophthalmology, Rudolf Foundation Clinic, Juchgasse 25, A-1030, Vienna, Austria.,Karl Landsteiner Institute for Retinal Research and Imaging, Juchgasse 25, A-1030, Vienna, Austria.,Department of Ophthalmology, Medical University of Graz, Graz, Austria.,Retina Center Vienna, Jacquingasse 41, 1030, Vienna, Austria
| | - Susanne Binder
- Department of Ophthalmology, Rudolf Foundation Clinic, Juchgasse 25, A-1030, Vienna, Austria.,Karl Landsteiner Institute for Retinal Research and Imaging, Juchgasse 25, A-1030, Vienna, Austria.,Retina Center Vienna, Jacquingasse 41, 1030, Vienna, Austria
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Martín-Begué N, Saint-Gerons M. Congenital optic nerve anomalies. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2016; 91:577-588. [PMID: 27378455 DOI: 10.1016/j.oftal.2016.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 05/28/2016] [Accepted: 05/30/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To update the current knowledge about congenital optic disc anomalies. METHODS A comprehensive literature search was performed in the major biomedical databases. RESULTS Patients with these anomalies usually have poor vision in infancy. Refractive errors are common, and serous retinal detachment may develop in some of these anomalies. It is critically important to clinically differentiate between these congenital optic disc anomalies, as central nervous system malformations are common in some, whereas others may be associated with systemic anomalies. CONCLUSIONS Congenital optic disc anomalies are a heterogeneous group of pathologies with characteristic fundus appearance and systemic associations. We should always try to make a correct diagnosis, in order to ask for specific tests, as well as to provide an adequate follow-up.
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Affiliation(s)
- N Martín-Begué
- Unidad de Oftalmología Pediátrica, Hospital Universitari Vall d'Hebron, Barcelona, España.
| | - M Saint-Gerons
- Servicio de Oftalmología, Hospital Mútua de Terrassa , Terrassa, Barcelona, España
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Cavazos-Adame H, Olvera-Barrios A, Martinez-Lopez-Portillo A, Mohamed-Hamsho J. Morning Glory Disc Anomaly, A Report of a Successfully Treated Case of Functional Amblyopia. J Clin Diagn Res 2015; 9:ND01-3. [PMID: 26557552 DOI: 10.7860/jcdr/2015/15086.6695] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 08/31/2015] [Indexed: 11/24/2022]
Abstract
Morning Glory Disc Anomaly (MGDA) is a congenital malformation of the optic nerve characterized by the presence of a funnel-shaped macropapilla with neuroglial remnants in its center surrounded by an elevated and pigmented chorioretinal ring. Its incidence is rare and no gender predisposition has been found. Associated conditions like strabismus lead to an early diagnosis. We report the case of a 3.8-year-old boy with amblyopia of the right eye (count fingers 0.3 meters) due to MGDA. Correction of the refractive error with glasses, along with occlusive therapy resulted in a visual acuity of 20/100 after a five-year follow up. The presence of amblyopia in these cases demands an early management oriented to improve the visual acuity. Every patient with an anatomical malformation diagnosed during the period of sensory maturation should be treated with occlusive therapy and followed on a regular basis to diagnose associated conditions such as retinal detachment. We recommend occlusive therapy in every patient diagnosed with MGDA or in any patient with unilateral or asymmetric structural abnormalities that could lead to amblyopia. This 5-year case follow-up provides additional evidence of the importance of treatment during the period of amblyopia reversibility.
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Affiliation(s)
- Humberto Cavazos-Adame
- Professor and Head of the Pediatric Ophthalmology and Strabismus Clinic, Department of Ophthalmology, University Hospital "Dr. Jose Eleuterio Gonzalez", Faculty of Medicine . Universidad Autonoma de Nuevo Leon, Mexico
| | - Abraham Olvera-Barrios
- Opthalmology Resident, Department of Ophthalmology, University Hospital "Dr. Jose Eleuterio Gonzalez", Faculty of Medicine . Universidad Autonoma de Nuevo Leon
| | - Alejandro Martinez-Lopez-Portillo
- Professor, Glaucoma and Optic Nerve Diseases Clinic, Department of Ophthalmology, University Hospital "Dr. Jose Eleuterio Gonzalez", Faculty of Medicine . Universidad Autonoma de Nuevo Leon, Mexico
| | - Jesus Mohamed-Hamsho
- Chief of the Department, Professor and Head of the Glaucoma and Optic Nerve Diseases Clinic, Department of Ophthalmology, University Hospital "Dr. Jose Eleuterio Gonzalez", Faculty of Medicine . Universidad Autonoma de Nuevo Leon, Mexico
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