Unique observations on swept source optical coherence tomography in a case of morning glory optic disc anomaly with associated retinal detachment.

A 7-year-old female presented with a diminution of vision in her right eye (RE) since birth, which was deteriorating further for the last few months. Her best-corrected visual-acuity (BCVA) was 20/400 in the RE and 20/20 in the left eye (LE). RE fundus showed funnel-shaped excavated optic disc (OD) suggestive of morning glory disc anomaly (MGDA) with an adjacent retinal detachment (RD), involving the macula. [Fig. 1a] A retinal break could not be identified clinically. Radial swept source optical coherence tomography (SS-OCT) (DRI-Topcon) scans revealed preretinal floating vitreous opacities, central fibrotic glial membrane (FGM) over the OD, cystoid retinal changes at various levels, subretinal white dots, and hump-like scleral protrusion through the defect. [Fig. 1b, c, and e] No visible connection could be traced between the subarachnoid space and subretinal space. A slit-shaped macular break was visible along the margin of the OD excavation. [Fig. 1d] The patient is currently on observation and conservative management.

Figure 1

(a) Ultra-wide field fundus imaging of morning glory optic disc anomaly with surrounding retinal detachment. (b) Swept source optical coherence tomography showing central fibrotic glial membrane (White arrow), scleral humps (Yellow arrow), and sub-retinal White dots. (c) One of the degenerative vitreous opacities (White arrow) along with cystoid retinal degeneration can be seen. (d) A slit-shaped retinal break (White arrow) over the margin of the excavation can be visualized. (e) Scleral protrusion is more prominently visible on this scan

MGDA, a rare OD anomaly, results from incomplete in utero optic nerve head closure and is associated with RDs in 26–38% of the patients.[12] Although histopathology reports have identified retinal herniation in MGDA,[3] hump-like reverse scleral protrusion through the defect is a novel finding. Floating yellowish degenerative vitreous opacities in MGDA were also noted. The cause of RD in MGDA is debatable, albeit most studies have identified a causative retinal break,[245] which is suspected to arise secondary to the tangential traction exerted by the FGM over the surrounding thinned out retina. A slit-shaped retinal break was noted over the scleral hump with the help of SS-OCT. Our study puts forth certain rare SS-OCT observations in the case of MGDA-RD.

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The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

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