Clinical analysis and management of pediatric retinal detachment associated with morning glory syndrome_Chinese Journal of Ocular Fundus Diseases

Authors：

FeiPing , ZhangQi , XuYu , 蔡璇 , 虞思伊 , 李家恺 , 金海鹰 , 亢晓丽 ,  赵培泉

Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China;

Corresponding author：

赵培泉, Email: zhaopeiquan@126.com

Keywords：

Optic nerve diseases/congenital; Retinal detachment/therapy; Laser coagulation; Vitrectomy

DOI：

10.3760/cma.j.issn.1005-1015.2014.01.012

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Objective To analyze and discuss the clinical features and management of pediatric retinal detachment (RD) associated with morning glory syndrome (MGS). Methods The clinical data of 49 patients (51 eyes) with RD associated with MGS were retrospectively analyzed, including 27 males (27 eyes) and 22 females (24 eyes). The age at first diagnosis ranged from 1 week after birth and 13 years old (4.2±3.2) years. There were 33 eyes of exudative RD, 3 eyes of rhegmatogenous RD and 15 eyes of RD with undetermined cause. Twenty eyes of 20 patients had other congenital ocular abnormalities, including persistent hyperplastic primary vitreous, microphthalmia, choroidal coloboma, iris coloboma. Besides retinal detachment, other complications were found, including cataract, secondary glaucoma,corneal leukoma or edema, strabismus and nystagmus. Twenty-two cases (22 eyes) received treatment. Five cases of mild exudative retinal detachment took oral methazolamide tablets. Three eyes with mild and restricted retinal detachments got retinal laser photocoagulation around the optic disc. Fourteen cases of 14 eyes underwent surgery including vitrectomy, lensectomy, and phacoemulsification. Follow-up after treatment were three months or more, with an average of (20.3±11.8) months. The visual acuity, retinal reattachment and intraocular pressure and other complications after treatment were followed up. Results Five patients of exudative retinal detachment were remained stable by taking methazolamide tablets. Two of the 3 eyes remained stable after laser therapy; however, the remaining one eye was not controlled after relaser. Cataract and glaucoma were resolved by lensectomy in 7 eyes and phaco-emulsification surgery in 1 eye. Retina was re-attached in 6 eyes after vitrectomy. Among those treated, 10 eyes had records of visual acuity. Visual acuity was improved in 1 eye after laser therapy and remained stable in 9 eyes. There were no drugs and surgery-related complications. Conclusions Retinal detachment was the main complication of MGS. The high incidence and poor prognosis call for the need of close follow-up and timely treatment, including medicine, laser and surgery.

Citation： FeiPing, ZhangQi, XuYu. Clinical analysis and management of pediatric retinal detachment associated with morning glory syndrome. Chinese Journal of Ocular Fundus Diseases, 2014, 30(1): 46-49. doi: 10.3760/cma.j.issn.1005-1015.2014.01.012 Copy

1.	Haik BG, Greenstein SH, Smith ME, et al. Retinal detachment in the morning glory anomaly[J]. Ophthalmology,1984,91:1638-1647.
2.	Coll GE, Chang S, Flynn TE, et al. Communication between the subretinal space and the vitreous cavity in the morning glory syndrome[J]. Graefe's Arch Clin Exp Ophthalmol,1995,233:441-443.
3.	Chang S, Gregory-Roberts E, Chen R. Retinal detachment associated with optic disc colobomas and morning glory syndrome[J]. Eye (Lond),2012,26:494-500.
4.	Kindler P. Morning glory syndrome:unusual congenital optic disk anomaly[J]. Am J Ophthalmol,1970,69:376-384.
5.	Harasymowycz P, Chevrette L, Décarie JC, et al. Morning glory syndrome:clinical, computerized tomographic, and ultrasonographic findings[J]. J Pediatr Ophthalmol Strabismus,2005,42:290-295.
6.	杨小丽,张皙.牵牛花综合征伴裂孔性视网膜脱离的玻璃体手术治疗(英文)[J].国际眼科杂志,2010,10:424-426.
7.	胡玉章,李宇,谭经果,等.牵牛花综合征伴视网膜脱离的手术治疗二例[J].中华眼底病杂志,2006,22:63-64.
8.	徐海燕,叶俊杰.牵牛花综合征合并视网膜脱离1例[J].中国医学科学院学报,2006,28:733-734,740.
9.	Jo YJ, Iwase T, Oveson BC, et al. Retinal detachment in morning glory syndrome with large hole in the excavated disc[J]. Eur J Ophthalmol,2011,21:841-844.
10.	Prakash P, De Salvo G, Lotery AJ. Morning glory with serous macular detachment responds to oral acetazolamide[J]. Eye (Lond),2010,24:1732-1733.
11.	Yamakiri K, Uemura A, Sakamoto T. Retinal detachment caused by a slitlike break within the excavated disc in morning glory syndrome[J]. Retina,2004,24:652-653.
12.	Ho TC, Tsai PC, Chen MS, et al. Optical coherence tomography in the detection of retinal break and management of retinal detachment in morning glory syndrome[J]. Acta Ophthalmol Scand,2006,84:225-227.
13.	Hamada S, Ellsworth RM. Congenital retinal detachment and the optic disk anomaly[J]. Am J Ophthalmol,1971,71:460-464.
14.	Choudhry N, Ramasubramanian A, Shields CL, et al. Spontaneous resolution of retinal detachment in morning glory disk anomaly[J]. J AAPOS,2009,13:499-500.
15.	Rojanaporn D, Kaliki S, Shields CL, et al. Morning glory disc anomaly with peripheral retinal nonperfusion in 4 consecutive cases[J]. Arch Ophthalmol,2012,130:1327-1330.
16.	Postel EA, Pulido JS, McNamara JA, et al. The etiology and treatment of macular detachment associated with optic nerve pits and related anomalies[J]. Trans Am Ophthalmol Soc,1998,96:73-93.
17.	Irvine AR, Crawford JB, Sullivan JH. The pathogenesis of retinal detachment with morning glory disc and optic pit[J]. Retina,1986,6:146-150.
18.	Bartz-Schmidt KU. Communication between the subretinal space and the vitreous cavity in the morning glory syndrome[J]. Graefe's Arch Clin Exp Ophthalmol,1996,234:409.

1. Haik BG, Greenstein SH, Smith ME, et al. Retinal detachment in the morning glory anomaly[J]. Ophthalmology,1984,91:1638-1647.
2. Coll GE, Chang S, Flynn TE, et al. Communication between the subretinal space and the vitreous cavity in the morning glory syndrome[J]. Graefe's Arch Clin Exp Ophthalmol,1995,233:441-443.
3. Chang S, Gregory-Roberts E, Chen R. Retinal detachment associated with optic disc colobomas and morning glory syndrome[J]. Eye (Lond),2012,26:494-500.
4. Kindler P. Morning glory syndrome:unusual congenital optic disk anomaly[J]. Am J Ophthalmol,1970,69:376-384.
5. Harasymowycz P, Chevrette L, Décarie JC, et al. Morning glory syndrome:clinical, computerized tomographic, and ultrasonographic findings[J]. J Pediatr Ophthalmol Strabismus,2005,42:290-295.
6. 杨小丽,张皙.牵牛花综合征伴裂孔性视网膜脱离的玻璃体手术治疗(英文)[J].国际眼科杂志,2010,10:424-426.
7. 胡玉章,李宇,谭经果,等.牵牛花综合征伴视网膜脱离的手术治疗二例[J].中华眼底病杂志,2006,22:63-64.
8. 徐海燕,叶俊杰.牵牛花综合征合并视网膜脱离1例[J].中国医学科学院学报,2006,28:733-734,740.
9. Jo YJ, Iwase T, Oveson BC, et al. Retinal detachment in morning glory syndrome with large hole in the excavated disc[J]. Eur J Ophthalmol,2011,21:841-844.
10. Prakash P, De Salvo G, Lotery AJ. Morning glory with serous macular detachment responds to oral acetazolamide[J]. Eye (Lond),2010,24:1732-1733.
11. Yamakiri K, Uemura A, Sakamoto T. Retinal detachment caused by a slitlike break within the excavated disc in morning glory syndrome[J]. Retina,2004,24:652-653.
12. Ho TC, Tsai PC, Chen MS, et al. Optical coherence tomography in the detection of retinal break and management of retinal detachment in morning glory syndrome[J]. Acta Ophthalmol Scand,2006,84:225-227.
13. Hamada S, Ellsworth RM. Congenital retinal detachment and the optic disk anomaly[J]. Am J Ophthalmol,1971,71:460-464.
14. Choudhry N, Ramasubramanian A, Shields CL, et al. Spontaneous resolution of retinal detachment in morning glory disk anomaly[J]. J AAPOS,2009,13:499-500.
15. Rojanaporn D, Kaliki S, Shields CL, et al. Morning glory disc anomaly with peripheral retinal nonperfusion in 4 consecutive cases[J]. Arch Ophthalmol,2012,130:1327-1330.
16. Postel EA, Pulido JS, McNamara JA, et al. The etiology and treatment of macular detachment associated with optic nerve pits and related anomalies[J]. Trans Am Ophthalmol Soc,1998,96:73-93.
17. Irvine AR, Crawford JB, Sullivan JH. The pathogenesis of retinal detachment with morning glory disc and optic pit[J]. Retina,1986,6:146-150.
18. Bartz-Schmidt KU. Communication between the subretinal space and the vitreous cavity in the morning glory syndrome[J]. Graefe's Arch Clin Exp Ophthalmol,1996,234:409.

Chinese Journal of Ocular Fundus Diseases

Clinical analysis and management of pediatric retinal detachment associated with morning glory syndrome

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