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   Table of Contents      
BRIEF REPORT
Year : 2003  |  Volume : 51  |  Issue : 2  |  Page : 182-183

Bilateral morning glory disc anomaly.


Department of Ophthalmology, AMRI Apollo Clinic, Kolkata, India

Correspondence Address:
N Deb
Department of Ophthalmology, AMRI Apollo Clinic, Kolkata
India
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Source of Support: None, Conflict of Interest: None


PMID: 12831152

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  Abstract 

Morning glory disc anomaly (MGDA) is usually known to be unilateral. We report an unusual case of a bilateral form of the disorder with an aim to distinguish it from other bilateral optic nerve head anomalies.

Keywords: Optic disc anomaly, bilateral, congenital


How to cite this article:
Deb N, Das R, Roy I S. Bilateral morning glory disc anomaly. Indian J Ophthalmol 2003;51:182-3

How to cite this URL:
Deb N, Das R, Roy I S. Bilateral morning glory disc anomaly. Indian J Ophthalmol [serial online] 2003 [cited 2019 Dec 15];51:182-3. Available from: http://www.ijo.in/text.asp?2003/51/2/182/14706

The morning glory disc anomaly (MGDA) is a congenital funnel-shaped excavation of the posterior fundus that incorporates the optic disc, resembling the morning glory flower. It was first distinguished by Kindler[1] in 1970 from other congenital disc lesions. It usually occurs as an unilateral condition, though bilateral lesions have been reported.[2],[3],[4],[5],[6] Morning glory discs are more common in females (2:1) and rare in African-Americans.[7] With rare exceptions, the MGDA is not part of a multisystem genetic disorder.


  Case report Top


A six-year-old girl presented with a history of poor vision and oscillation of eyes since infancy. Systemic, gestational and family history was unremarkable. On examination, her visual acuity was counting fingers (CF) close to face in the right eye and CF at half metre in the left eye. External examination revealed the presence of mild hypertelorism but no other soft tissue or bony abnormality. A right esodeviation with pendular nystagmus was present. Slitlamp examination revealed bilateral microphthalmos. Intraocular pressure (IOP) checked digitally was normal in both eyes.

Fundus examination in both eyes revealed the presence of a funnel-shaped excavation containing an enlarged, somewhat indistinct, optic disc surrounded by a wide annulus of chorioretinal pigmentary disturbance [Figure - 1]a, b. A white tuft of glial tissue lay over the central portion of the disc and blood vessels emanated radially from the disc margin. Sensory detachment of the retina extending from the peripapillary to the inferior retina was seen in both eyes. Retinal breaks could not be detected. The excavation was seen to engulf the macula in the right eye (macular capture).

Ocular ultrasonography in both eyes confirmed the presence of anomalous funnel shaped excavation of the posterior fundus incorporating the optic nerve head and presence of retinal detachment [Figure - 2]a, b. The axial length of the eyeball measured at the edge of the coloboma was 19 mm in both eyes. Low to moderate reflective clump-like echoes in front of the optic nerve head were seen corresponding to the glial tuft seen clinically. Computerised Tomography scan [Figure - 3]a, b showed bilateral funnel shaped enlargement of the distal optic nerve at its junction with the globe. There was no evidence of altered radiodensity of the orbital optic nerve or any basal encephalocele. Systemic examination revealed normal findings.

The extremely guarded visual prognosis in view of the anatomic anomaly and the possibility of dense amblyopia was clearly explained. The option of vitreous surgery with subretinal fluid drainage, gas tamponade and peripapillary photocoagulation8 was discussed for the left, i.e., the better eye, and patient was advised to attend a tertiary care centre.


  Discussion Top


MGDA is usually unilateral[7] whereas our patient had an uncommon bilateral presentation. MGDA is a descriptive classification for a characteristic lesion of the optic nerve. It needs to be distinguished from the other congenital disc lesions, especially optic nerve coloboma (ONC) and peripapillary staphyloma.[7] ONC, unlike MGDA, has no gender predilection, is often familial, bilateral and associated with multisystem genetic disorders.[7] Ophthalmoscopically, the two entities are distinct - the morning glory disc lies symmetrically and centrally within the excavation, whereas in ONC the excavation lies aymmetrically, and usually inferiorly within the optic disc.

The absence of central glial hyperplasia, peripa-pillary depigmentation and anomalous retinal vasculature distinguishes ONC from MGDA. A comparatively deeper cup-shaped excavation, a relatively normal, well defined optic disc and the absence of glial and vascular anomalies characterise peripapillary staphyloma.[7]

Among associated ocular anomalies, retinal detachment, both serous and rhegmatogenous, occurs in about one-third (26-38%) cases of MGDA and was also noted in our patient whereas iris, ciliary, retinal colobomas and orbital cysts are more commonly associated with ONC.[3],[5] Morning glory discs are usually associated with intracranial disorders like basal encephalocele, agenesis of corpus callosum, and absence of chiasm[2],[7] but there features were absent in our patient.

The clinical features and ancillary investigations establish the diagnosis of MGDA in our patient. [6] The purpose of reporting this case is to highlight the possibility of a rare bilateral existence of MGDA and to differentiate it from the other excavated anomalies of the optic nerve head which could also present bilaterally but differ in their management and prognosis.

 
  References Top

1.
Kindler P. Morning Glory Syndrome: Unusual congenital optic disc anomaly. Am J Ophthalmol 1970;69:376-84.   Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.
Itakura T, Miyamoto K, Uematsu Y. J Neurosurg 1992;77:949-51.  Back to cited text no. 2
    
3.
Akiyama K, Azuma N, Hida T, Uemura Y.Retinal detachment in Morning Glory syndrome. Ophthalmic Surg 1984;15:841-43.   Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.
De Laey JJ, Ryckaert S, Leys A. The Morning Glory syndrome. Ophthalmic Paediatr Genet 1985;5117-24.   Back to cited text no. 4
    
5.
Von Fricken MA, Dhungel R. Retinal detachment in the morning glory syndrome: pathogenesis and management. Retina 1984;4:97-99.   Back to cited text no. 5
[PUBMED]  [FULLTEXT]  
6.
Beyer WB, Quencer RM, Osher RH. Morning Glory Syndrome: A functional analysis including fluorescein angiography, ultrasonography and computerized tomography. Ophthalmology 1982;89:1362-67.   Back to cited text no. 6
[PUBMED]  [FULLTEXT]  
7.
Miller NR, Newman NJ, editors. Anomalies of the optic disc. In: The essentials: Walsh & Hoyt's Clinical Neuroophthalmology. 5th ed. Williams & Williams 1999. pp. 117-23.  Back to cited text no. 7
    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3]


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