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Morning Glory Disc Anomaly Discovered in an African American Preterm Infant. Jason Sorell, DO Suzie Nemmers MD Robert Ridout,MD , Sarah Lentz-Kapua, MD

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morning glory disc anomaly discovered in an african american preterm infant

Morning Glory Disc AnomalyDiscovered 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.

purpose objective
Purpose/Objective
  • To report a case of morning glory disc anomaly (MGDA) in a premature African American male infant
background
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.
methods
Observational case study

Literature Review

History & Ocular Exam

Brain MRI/MRA

A&B-scan

Methods

OD

OD

OS

OS

literature review
Literature Review
  • MGDA is rare in African Americans3,4 and more common in females than males (2:1).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
associated systemic anomalies 1 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

Associated Systemic Anomalies1,5,11
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

Va=RTL OU; No RAPD

Ttp=17 OU

External ocular exam & anterior segment unremarkable except cornea diameter of OD < OS (7x7mm & 9.5x9.5mm respectively)

Results
results10
A-scan:OD OS

AxL: 17.4 18.2mm

B-scan: possible excavation

MRI: no intracranial vascular anomaly

Patent ductus arteriosus ligation

Results
conclusions
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
bibliography
Bibliography
  • 1. Lenhart P, Lambert S, Newman N, et al. Intravascular anomalies in patients with morning glory disc anomaly. Am J Ophthalmol. 2006 Oct;142(4):644-50.
  • 2. Kindler P. Morning glory syndrome an unusual optic disc anomaly. Am J Ophthalmol 1970; 69:376.
  • 3. Steinkuller P. The morning glory disk anomaly: case report and literature review. J Pediatr Ophthalmol Strabismus 1980; 17:81-87.
  • 4. Pollock S; The morning glory disc anomaly: contractile movement, classification, and embryogenesis. Doc Ophthalmol 1987; 65:439-460.
  • 5. Brodsky, MC. Congenital optic disk anomalies. Surv of Ophthalmol 1994; 39:89-112.
  • 6. Kushner BJ: Functional amblyopia associated with abnormalities of the opitc nerve. Arch Ophthalmol 102:683-85, 1985
  • 7. Haik BG, Greenstein SH, Smith ME, et al: Retinal detachment in the morning glory syndrome. Ophthalmology 91:1638-47, 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; 97:596-600.
  • 10. Fricken, MA, Dhungel, R. Retinal detachment in the morning glory syndrome. Retina 1984; 4:97-99
  • 11. Eustis HS, Sanders MR, Zimmerman T: Morning Glory Syndrome in Children. Arch Ophthalmol 112:204-207,1994