Jo Young-Joon, Iwase Takeshi, Oveson Brian C, Tanaka Nobushige
Department of Ophthalmology, Chungnam National University Hospital, Daejeon, Korea.
Eur J Ophthalmol. 2011 Nov-Dec;21(6):841-4. doi: 10.5301/EJO.2011.8365.
To present a case of morning glory syndrome (MGS) associated with retinal detachment and to discuss the pathogenesis of retinal tear.
A 2-year-old-girl had a MGS with a large hole in the excavated disc and retinal detachment. The visual acuity was 4/200 in the affected eye. The excavated disc and retinal detachment were confirmed by echogram. Optical coherence tomography demonstrated that the large hole was connected to the subretinal space. The excavated lesion did not show contractions. The detachment area and the volume of subretinal fluid rose and fell between initial examinations, but ultimately increased. After 2 years of observations, surgery was performed as the retinal detachment had enlarged to include the macula.
Surgery included triamcinolone-assisted vitrectomy, subretinal fluid drainage through the large hole in the excavated disc, retinal photocoagulation along the excavated disc, and long-acting gas tamponade. One month later, the retina was redetached due to incomplete closure of the hole. A second operation was performed using silicone oil tamponade. Ultimately, the retina was reattached after silicone oil-fluid exchange surgery.
One possible reason for a large hole in an excavated disc is origination of the tear from a congenital defect, such as an optic pit. The retinal detachment in patients with MGS with a large hole in the disc can be treated with triamcinolone-assisted pars plana vitrectomy and retinal photocoagulation along the excavated disc. This case has shown that one critical component for a high success rate is the tamponade agent used in the vitreous.
报告一例与视网膜脱离相关的牵牛花综合征（MGS）病例，并探讨视网膜裂孔的发病机制。
一名2岁女童患有牵牛花综合征，视盘凹陷处有一个大裂孔并伴有视网膜脱离。患眼视力为4/200。通过超声检查证实了视盘凹陷和视网膜脱离。光学相干断层扫描显示大裂孔与视网膜下间隙相连。视盘凹陷病变未显示收缩。在初次检查之间，视网膜脱离区域和视网膜下液体积有波动，但最终增加。经过2年观察，由于视网膜脱离扩大至累及黄斑，遂进行手术。
手术包括曲安奈德辅助玻璃体切除术、通过视盘凹陷处的大裂孔引流视网膜下液、沿视盘凹陷处进行视网膜光凝以及长效气体填充。一个月后，由于裂孔闭合不完全，视网膜再次脱离。第二次手术采用硅油填充。最终，在硅油-液体交换手术后视网膜重新复位。
视盘凹陷处出现大裂孔的一个可能原因是裂孔起源于先天性缺陷，如视凹。对于视盘有大裂孔的牵牛花综合征患者，视网膜脱离可通过曲安奈德辅助的玻璃体切除术和平坦部视网膜光凝进行治疗。该病例表明，高成功率的一个关键因素是玻璃体中使用的填充剂。
