Retina

Case 67

Patient Presentation: A 41-year-old woman presented with 3 days of acute painless decrease in vision OD. She denied flashes, floaters or a visual field deficit. There was no trauma. The patient denied any relevant past medical or ocular history. She did however note that an optometrist once mentioned she had an atypical optic nerve. Best corrected distance visual acuity was 20/200 OD and 20/20 OS. There was a right RAPD.

Fundoscopy and OCT macula were done and shown below:

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Question 1: Which of the following describes the main findings of this right eye OCT macula? 

Question 2: Based on the patient’s history, OCT, and fundus findings, what is the most likely diagnosis?

Fundus autofluorescence photos were taken and are shown below. Note the juxtapapillary hypo-autofluorescence in keeping with the excavation of the optic nerve due to RPE loss/atrophy, as well as the hyper-autofluorescence at the macula reflecting the accumulation of subretinal fluid. The left eye is provided as well for reference.

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Question 3: Which of the following are NOT typical complications of this condition?

Question 4: What workup do ALL patients with this condition require?

References:

  1. Dedhia, C. J., Gogri, P. Y., & Rani, P. K. (2016). Rare bilateral presentation of morning glory disc anomaly. BMJ case reports, 2016, bcr2016215846. https://doi.org/10.1136/bcr-2016-215846

  2. Martins, T. G., Martins, D. G., & Costa, A. L. (2015). Patient with Morning Glory syndrome. Einstein (Sao Paulo, Brazil), 13(1), 165–166. https://doi.org/10.1590/S1679-45082015AI2902

  3. Morioka, M., Marubayashi, T., Masumitsu, T., Miura, M., & Ushio, Y. (1995). Basal encephaloceles with morning glory syndrome, and progressive hormonal and visual disturbances: case report and review of the literature. Brain & development, 17(3), 196–201. https://doi.org/10.1016/0387-7604(95)00021-3

  4. Pierre-Filho, P., Limeira-Soares, P. H., & Marcondes, A. M. (2004). Morning glory syndrome associated with posterior pituitary ectopia and hypopituitarism. Acta ophthalmologica Scandinavica, 82(1), 89–92. https://doi.org/10.1111/j.1395-3907.2004.00214.x

  5. Shigeru Sato, Takeshi Morimoto, Sayaka Tanaka, Motokazu Tsujikawa, Kohji Nishida. Choroidal Neovascularization Associated with Morning Glory Syndrome: A Case Report. Archives of Clinical and Medical Case Reports 4 (2020): 1023-1030.

  6. Srinivasan, G., Venkatesh, P., & Garg, S. (2007). Optical coherence tomographic characteristics in morning glory disc anomaly. Canadian journal of ophthalmology. Journal canadien d'ophtalmologie, 42(2), 307–309.

  7. Wang, Y. Y., Zhou, K. Y., Ye, Y., Song, F., Yu, J., Chen, J. C., & Yao, K. (2020). Moyamoya Disease Associated With Morning Glory Disc Anomaly and Other Ophthalmic Findings: A Mini-Review. Frontiers in neurology, 11, 338. https://doi.org/10.3389/fneur.2020.00338

 

Learning Objectives:

  1. To identify fundus findings and OCT imaging of Morning Glory Syndrome

  2. To understand the associated complications of Morning Glory Syndrome and the recommended workup