Morning Glory Disc Anomaly Discovered in an African American Preterm Infant

1
Morning Glory Disc Anomaly Discovered in an
African American Preterm Infant

• Jason Sorell, DO Suzie Nemmers MD
• Robert Ridout,MD , Sarah Lentz-Kapua, MD
• The views expressed in this poster are those of
  the authors and do not reflect the official
  policy or position of the Department of the Army,
  Department of Defense of the U.S. Government.

2
Purpose/Objective

• To report a case of morning glory disc anomaly
  (MGDA) in a premature African American male
  infant

3
Background

• MGDA is a congenital abnormality, funnel-shaped
  excavation of the posterior fundus that
  incorporates the optic disk.5
• MGDA may result when incomplete neuroectodermal
  development leads to an abnormal closure of the
  embryonic fissure.

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Methods

• Observational case study
• Literature Review

• History Ocular Exam
• Brain MRI/MRA
• AB-scan

OD
OS
OD
OS
5
Literature Review

• MGDA is rare in African Americans3,4 and more
  common in females than males (21).3,4,5
• MGDA is almost always unilateral and typically
  presents in early childhood as amblyopia and
  strabismus.2,3,4,5
• Kushner successfully treated patients with
  functional amblyopia secondary to structural
  optic nerve abnormalities.6
• Non-rhegmatogenous retinal detachments reported
  in 25-38 of MGDA5

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Associated Systemic Anomalies1,5,11

• In a retrospective observational case series, 9
  of 20 patients (45) with MGDA had identifiable
  cerebrovascular anomalies .Three required
  revascularization procedures and three were
  diagnosed with Moyamoya disease.1

• Panhypopituitarism
• Basal encephalocele
• Absent corpus callosum
• cleft lip/palate, hypertelorism

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Results

• A premature African American male born at 28
  weeks gestation was found to have MGD of OD
  stage 1 ROP, zone II in OU on fundus exam during
  ROP screening. He also had microphthalmia of OD.
  
• Birth wt 1110g

• No craniofacial abnormalities
• VaRTL OU No RAPD
• Ttp17 OU
• External ocular exam anterior segment
  unremarkable except cornea diameter of OD lt OS
  (7x7mm 9.5x9.5mm respectively)

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OD
9
OS
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Results

• A-scan OD OS
• AxL 17.4 18.2mm
• B-scan possible excavation

• MRI no intracranial vascular anomaly
• Patent ductus arteriosus ligation

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Conclusions

• MGDA can occur in African Americans.
• Children with MGDA should undergo MRI/MRA or CT
  angiography to detect associated vascular and
  structural brain anomalies.1
• A growth evaluation is recommended to detect
  possible panhypopituitarism.11
• A trial of occlusion therapy for functional
  amblyopia is warranted.5,6
• Closely follow for possible retinal
  detachment.7,8,9,10

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Bibliography

• 1. Lenhart P, Lambert S, Newman N, et al.
  Intravascular anomalies in patients with morning
  glory disc anomaly. Am J Ophthalmol. 2006
  Oct142(4)644-50.
• 2. Kindler P. Morning glory syndrome an unusual
  optic disc anomaly. Am J Ophthalmol 1970 69376.
  
• 3. Steinkuller P. The morning glory disk
  anomaly case report and literature review. J
  Pediatr Ophthalmol Strabismus 1980 1781-87.
• 4. Pollock S The morning glory disc anomaly
  contractile movement, classification, and
  embryogenesis. Doc Ophthalmol 1987 65439-460.
• 5. Brodsky, MC. Congenital optic disk anomalies.
  Surv of Ophthalmol 1994 3989-112.
• 6. Kushner BJ Functional amblyopia associated
  with abnormalities of the opitc nerve. Arch
  Ophthalmol 102683-85, 1985
• 7. Haik BG, Greenstein SH, Smith ME, et al
  Retinal detachment in the morning glory syndrome.
  Ophthalmology 911638-47, 1984.
• 8. Akiyama K, Azuma N, Hida T, Uemura Y. Retinal
  detachment in morning glory syndrome. Ophthalmic
  surgery. 1984 15 841-83.
• 9. Chang S, et al. Treatment of total retinal
  detachment in morning glory syndrome. Am J
  Ophthalmol 1984 97596-600.
• 10. Fricken, MA, Dhungel, R. Retinal detachment
  in the morning glory syndrome. Retina 1984
  497-99
• 11. Eustis HS, Sanders MR, Zimmerman T Morning
  Glory Syndrome in Children. Arch Ophthalmol
  112204-207,1994