Retinal detachment in morning glory syndrome with large hole in the excavated disc.

PURPOSE

To present a case of morning glory syndrome (MGS) associated with retinal detachment and to discuss the pathogenesis of retinal tear.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.