The status and progress of morning glory syndrome_Chinese Journal of Ocular Fundus Diseases

Authors：

She Kaiqin , Zhang Qi ,  Zhao Peiquan

Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiaotong University, School of Medicine, Shanghai 200092, China;

Corresponding author：

Zhao Peiquan, Email: zhaopeiquan@xinhuamed.com.cn

Keywords：

optic nerve disease/congenital; retinal detachment/treatment; photocoagulation; vitrectomy; association; treatment; review

DOI：

10.3760/cma.j.issn.1005-1015.2017.05.034

Video：

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Morning glory syndrome (MGS) is a congenital optic disc anomaly. The characteristic ophthalmoscopic findings consist of a generally enlarged, funnel-shaped and excavated optic disc, surrounded by an elevated annulus of chorioretinal pigment disturbance, with a central glial tuft, multiple narrow branches of retina vessels radiating from the disc. There are peripheral non-perfusion retinal areas in most cases. The pathogenesis of MGS remains unclear. MGS might be associated with many ocular and systemic abnormalities, involving facial, central nervous, cerebrovascular and endocrine systems. Persistent hyperplastic primary vitreous and retinal detachments (RD) are the most common ocular complications of MGS. The mechanism RD in MGS is unclear. Vitrectomy with long-acting gas or silicone tamponade and photocoagulation around the breaks or the enlarged disc might be efficient for rhegmatogenous RD of MGS. Early diagnosis is crucial for recognition and treatment of the ocular and systemic complications, and maintenance of the visual function.

Citation： She Kaiqin, Zhang Qi, Zhao Peiquan. The status and progress of morning glory syndrome. Chinese Journal of Ocular Fundus Diseases, 2017, 33(5): 557-560. doi: 10.3760/cma.j.issn.1005-1015.2017.05.034 Copy

1.	Kindler P. Morning glory syndrome: unusual congenital optic disk anomaly[J]. Am J Ophthalmol, 1970, 69(3): 376-384.
2.	Ceynowa DJ, Wickström R, Olsson M, et al. Morning glory disc anomaly in childhood - a population-based study[J]. Acta Ophthalmol, 2015, 93(7): 626-634. DOI: 10.1111/aos.12778. DOI: 10.1111/aos.12778.
3.	Harasymowycz P, Chevrette L, Décarie JC, et al. Morning glory syndrome: clinical, computerized tomographic, and ultrasonographic findings[J]. J Pediatr Ophthalmol Strabismus, 2005, 42(5): 290-295.
4.	Rojanaporn D, Kaliki S, Shields CL, et al. Morning glory disc anomaly with peripheral retinal nonperfusion in 4 consecutive cases[J]. Arch Ophthalmol, 2012, 130(10): 1327-1330. DOI: 10.1001/archophthalmol.2012.505.
5.	彭婕, 张琦, 费萍, 等.儿童牵牛花综合征患眼荧光素眼底血管造影特征[J]. 中华眼底病杂志, 2015, 31(4): 355-358. DOI: 10.3760/cma.j.issn.1005-1015.2015.04.011.Peng J, Zhang Q, Fei P, et al. Fundus fluorescein angiography of pediatric morning glory syndrome patients[J]. Chin J Ocul Fundus Dis, 2015, 31(4): 355-358. DOI: 10.3760/cma.j. issn.1005-1015. 2015.04.011.
6.	Beyer WB, Quencer RM, Osher RH.Morning glory syndrome: a functional analysis including fluorescein angiography, ultrasonography, and computerized tomography[J]. Ophthalmology, 1982, 89(12): 1362-1367.
7.	费萍, 张琦, 许宇, 等.儿童牵牛花综合征并发视网膜脱离的临床特征及治疗效果观察[J]. 中华眼底病杂志, 2014, 30(1): 46-49. DOI: 10.3760/cma.j.issn.1005-1015.2014.01.012.Fei P, Zhang Q, Xu Y, et al. Clinical analysis and management of pediatric retinal detachment associated with morning glory syndrome[J]. Chin J Ocul Fundus Dis, 2014, 30(1): 46-49. DOI: 10.3760/ cma.j.issn.1005-1015.2014.01.012.
8.	Fei P, Zhang Q, Li J, et al. Clinical characteristics and treatment of 22 eyes of morning glory syndrome associated with persistent hyperplastic primary vitreous[J]. Br J Ophthalmol, 2013, 97(10): 1262-1267. DOI: 10.1136/bjophthalmol-2013-303565.
9.	Cao XG, Li XX, Bao YZ. Morning glory syndrome associated with posterior lenticonus[J]. Open Neurol J, 2009, 3: 45-47. DOI: 10.2174/1874205X00903010045.
10.	Puvanachandra N, Heran MK, Lyons CJ. Morning glory disk anomaly with ipsilateral capillary hemangioma, agenesis of the internal carotid artery, and Horner syndrome: a variant of PHACES syndrome?[J]. J AAPOS, 2008, 12(5): 528-530. DOI: 10.1016/j.jaapos.2008.04.005.
11.	Saab MG, Cordahi GP, Rezende FA.Fibrin sealant in the treatment of retinal detachment in morning glory syndrome[J]. Retin Cases Brief Rep, 2011, 5(4): 326-329. DOI: 10.1097/ICB.0b013e3181ff0937.
12.	Haik BG, Greenstein SH, Smith ME, et al. Retinal detachment in the morning glory anomaly[J]. Ophthalmology, 1984, 91(12): 1638-1647.
13.	Chang S, Gregory-Roberts E, Chen R.Retinal detachment associated with optic disc colobomas and morning glory syndrome[J]. Eye (Lond), 2012, 26(4): 494-500. DOI: 10.1038/eye.2011.354.
14.	Morioka M, Marubayashi T, Masumitsu T, et al. Basal encephaloceles with morning glory syndrome, and progressive hormonal and visual disturbances: case report and review of the literature[J]. Brain Dev, 1995, 17(3): 196-201.
15.	Asakura Y, Muroya K, Hanakawa J, et al. Combined pituitary hormone deficiency with unique pituitary dysplasia and morning glory syndrome related to a heterozygous PROKR2 mutation[J]. Clin Pediatr Endocrinol, 2015, 24(1): 27-32. DOI: 10.1297/cpe.24.27.
16.	Nezzar H, Mbekeani JN, Dalens H.Morning glory syndrome with carotid and middle cerebral artery vasculopathy [J]. Optom Vis Sci, 2015, 92(12): 437-441. DOI: 10.1097/OPX.0000000000000727.
17.	Taşkintuna I, Oz O, Teke MY, et al. Morning glory syndrome: association with moyamoya disease, midline cranial defects, central nervous system anomalies, and persistent hyaloid artery remnant[J]. Retina, 2003, 23(3): 400-402.
18.	Lenhart PD, Lambert SR, Newman NJ, et al. Intracranial vascular anomalies in patients with morning glory disk anomaly[J]. Am J Ophthalmol, 2006, 142(4): 644-650. DOI: 10.1016/j.ajo.2006.05.040.
19.	Ganesh A, Mitra S, Koul RL, et al. The full spectrum of persistent fetal vasculature in Aicardi syndrome: an integrated interpretation of ocular malformation[J]. Br J Ophthalmol, 2000, 84(2): 227-228.
20.	Cennamo G, de Crecchio G, Iaccarino G, et al. Evaluation of morning glory syndrome with spectral optical coherence tomography and echography[J]. Ophthalmology, 2010, 117(6): 1269-1273. DOI: 10.1016/j.ophtha.2009.10.045.
21.	Ellika S, Robson CD, Heidary G, et al. Morning glory disc anomaly: characteristic MR imaging findings[J]. AJNR Am J Neuroradiol, 2013, 34(10): 2010-2014. DOI: 10.3174/ajnr.A3542.
22.	Giuffrè G.Morning glory syndrome: clinical and electrofunctional study of three cases[J]. Br J Ophthalmol, 1986, 70(3): 229-236.
23.	Chan RT, Chan HH, Collin HB.Morning glory syndrome[J]. Clin Exp Optom, 2002, 85(6): 383-388.
24.	Heidary G. Congenital optic nerve anomalies and hereditary optic neuropathies[J]. J Pediatr Genet, 2014, 3(4): 271-280. DOI: 10.3233/PGE-14108.
25.	Amador-Patarroyo MJ, Pérez-Rueda MA, Tellez CH.Congenital anomalies of the optic nerve[J]. Saudi J Ophthalmol, 2015, 29(1): 32-38. DOI: 10.1016/j.sjopt.2014.09.011.
26.	Cavazos-Adame H, Olvera-Barrios A, Martinez-Lopez-Portillo A, et al. Morning glory disc anomaly: a report of a successfully treated case of functional amblyopia[J]. J Clin Diagn Res, 2015, 9(10): 1-3. DOI: 10.7860/JCDR/2015/15086.6695.
27.	Loudot C, Fogliarini C, Baeteman C, et al. Rehabilitation on functional amblyopia in morning glory syndrome[J]. J Fr Ophtalmol, 2007, 30(10): 998-1001.
28.	Ho CL, Wei LC.Rhegmatogenous retinal detachment in morning glory syndrome pathogenesis and treatment[J]. Int Ophthalmol, 2001, 24(1): 21-24.
29.	Yamakiri K, Uemura A, Sakamoto T. Retinal detachment caused by a slitlike break within the excavated disc in morning glory syndrome[J]. Retina, 2004, 24(4): 652-653.
30.	Ho TC, Tsai PC, Chen MS, et al. Optical coherence tomography in the detection of retinal break and management of retinal detachment in morning glory syndrome[J]. Acta Ophthalmol Scand, 2006, 84(2): 225-227.
31.	Yang XL, Zhang X.Vitrectomy of rhegmatogenous retinal detachment in morning glory syndrome[J]. Int J Ophthalmol, 2010, 3(1): 89-91. DOI: 10.3980/j.issn.2222-3959.2010.01.21.
32.	童毓华, 马进, 张怡.玻璃体切割手术治疗伴黄斑裂孔及增生性视网膜脱离的小儿牵牛花综合征[J]. 中华眼底病杂志, 2013, 29(2): 206-208. DOI: 10.3760/cma.j.issn.1005-1015.2013.02.023.Tong YH, Ma J, Zhang Y.Vitrectomy for children morning glory syndrome with macular hole and poliferative retinal detachment [J]. Chin J Ocul Fundus Dis, 2013, 29(2): 206-208. DOI: 10.3760/cma.j.issn.1005-1015.2013.02.023.
33.	Naseripour M, Ghasempour A, Falavarjani KG, et al. Perfluorocarbon liquid migration into the subarachnoid space in a patient with morning glory syndrome[J]. J Curr Ophthalmol, 2015, 27(1-2): 60-62. DOI: 10.1016/j.joco.2015.09.004.
34.	Azuma N, Yamaguchi Y, Handa H, et al. Mutations of the PAX6 gene detected in patients with a variety of optic-nerve malformations[J]. Am J Hum Genet, 2003, 72(6): 1565-1570. DOI: 10.1086/375555.
35.	Nallathambi J, Neethirajan G, Shashikant S, et al. PAX6 missense mutations associated in patients with optic nerve malformation[J]. Mol Vis, 2006, 12: 236-242.
36.	Guerra-Junior G, Spinola-Castro AM, Siviero-Miachon AA, et al. Absence of mutations in Pax6 gene in three cases of morning glory syndrome associated with isolated growth hormone deficiency[J]. Arq Bras Endocrinol Metabol, 2008, 52(8): 1221-1227.
37.	Cennamo G, Liguori G, Pezone A, et al. Morning glory syndrome associated with marked persistent hyperplastic primary vitreous and lens colobomas[J]. Br J Ophthalmol, 1989, 73(8): 684-686.
38.	Pedler C.Unusual coloboma of the optic nerve entrance[J]. Br J Ophthalmol, 1961, 45(12): 803-807.
39.	Dempster AG, Lee WR, Forrester JV, et al. The 'morning glory syndrome' - a mesodermal defect?[J]. Ophthalmologica, 1983, 187(4): 222-230.
40.	Manschot WA.Morning glory syndrome: a histopathological study[J]. Br J Ophthalmol, 1990, 74(1): 56-58.
41.	Irvine AR, Crawford JB, Sullivan JH.The pathogenesis of retinal detachment with morning glory disc and optic pit[J]. Retina, 1986, 6(3): 146-150.
42.	Nagasawa T, Mitamura Y, Katome T, et al. Swept-source optical coherence tomographic findings in morning glory syndrome[J]. Retina, 2014, 34(1): 206-208. DOI: 10.1097/IAE.0b013e318296575c.

1. Kindler P. Morning glory syndrome: unusual congenital optic disk anomaly[J]. Am J Ophthalmol, 1970, 69(3): 376-384.
2. Ceynowa DJ, Wickström R, Olsson M, et al. Morning glory disc anomaly in childhood - a population-based study[J]. Acta Ophthalmol, 2015, 93(7): 626-634. DOI: 10.1111/aos.12778. DOI: 10.1111/aos.12778.
3. Harasymowycz P, Chevrette L, Décarie JC, et al. Morning glory syndrome: clinical, computerized tomographic, and ultrasonographic findings[J]. J Pediatr Ophthalmol Strabismus, 2005, 42(5): 290-295.
4. Rojanaporn D, Kaliki S, Shields CL, et al. Morning glory disc anomaly with peripheral retinal nonperfusion in 4 consecutive cases[J]. Arch Ophthalmol, 2012, 130(10): 1327-1330. DOI: 10.1001/archophthalmol.2012.505.
5. 彭婕, 张琦, 费萍, 等.儿童牵牛花综合征患眼荧光素眼底血管造影特征[J]. 中华眼底病杂志, 2015, 31(4): 355-358. DOI: 10.3760/cma.j.issn.1005-1015.2015.04.011.Peng J, Zhang Q, Fei P, et al. Fundus fluorescein angiography of pediatric morning glory syndrome patients[J]. Chin J Ocul Fundus Dis, 2015, 31(4): 355-358. DOI: 10.3760/cma.j. issn.1005-1015. 2015.04.011.
6. Beyer WB, Quencer RM, Osher RH.Morning glory syndrome: a functional analysis including fluorescein angiography, ultrasonography, and computerized tomography[J]. Ophthalmology, 1982, 89(12): 1362-1367.
7. 费萍, 张琦, 许宇, 等.儿童牵牛花综合征并发视网膜脱离的临床特征及治疗效果观察[J]. 中华眼底病杂志, 2014, 30(1): 46-49. DOI: 10.3760/cma.j.issn.1005-1015.2014.01.012.Fei P, Zhang Q, Xu Y, et al. Clinical analysis and management of pediatric retinal detachment associated with morning glory syndrome[J]. Chin J Ocul Fundus Dis, 2014, 30(1): 46-49. DOI: 10.3760/ cma.j.issn.1005-1015.2014.01.012.
8. Fei P, Zhang Q, Li J, et al. Clinical characteristics and treatment of 22 eyes of morning glory syndrome associated with persistent hyperplastic primary vitreous[J]. Br J Ophthalmol, 2013, 97(10): 1262-1267. DOI: 10.1136/bjophthalmol-2013-303565.
9. Cao XG, Li XX, Bao YZ. Morning glory syndrome associated with posterior lenticonus[J]. Open Neurol J, 2009, 3: 45-47. DOI: 10.2174/1874205X00903010045.
10. Puvanachandra N, Heran MK, Lyons CJ. Morning glory disk anomaly with ipsilateral capillary hemangioma, agenesis of the internal carotid artery, and Horner syndrome: a variant of PHACES syndrome?[J]. J AAPOS, 2008, 12(5): 528-530. DOI: 10.1016/j.jaapos.2008.04.005.
11. Saab MG, Cordahi GP, Rezende FA.Fibrin sealant in the treatment of retinal detachment in morning glory syndrome[J]. Retin Cases Brief Rep, 2011, 5(4): 326-329. DOI: 10.1097/ICB.0b013e3181ff0937.
12. Haik BG, Greenstein SH, Smith ME, et al. Retinal detachment in the morning glory anomaly[J]. Ophthalmology, 1984, 91(12): 1638-1647.
13. Chang S, Gregory-Roberts E, Chen R.Retinal detachment associated with optic disc colobomas and morning glory syndrome[J]. Eye (Lond), 2012, 26(4): 494-500. DOI: 10.1038/eye.2011.354.
14. Morioka M, Marubayashi T, Masumitsu T, et al. Basal encephaloceles with morning glory syndrome, and progressive hormonal and visual disturbances: case report and review of the literature[J]. Brain Dev, 1995, 17(3): 196-201.
15. Asakura Y, Muroya K, Hanakawa J, et al. Combined pituitary hormone deficiency with unique pituitary dysplasia and morning glory syndrome related to a heterozygous PROKR2 mutation[J]. Clin Pediatr Endocrinol, 2015, 24(1): 27-32. DOI: 10.1297/cpe.24.27.
16. Nezzar H, Mbekeani JN, Dalens H.Morning glory syndrome with carotid and middle cerebral artery vasculopathy [J]. Optom Vis Sci, 2015, 92(12): 437-441. DOI: 10.1097/OPX.0000000000000727.
17. Taşkintuna I, Oz O, Teke MY, et al. Morning glory syndrome: association with moyamoya disease, midline cranial defects, central nervous system anomalies, and persistent hyaloid artery remnant[J]. Retina, 2003, 23(3): 400-402.
18. Lenhart PD, Lambert SR, Newman NJ, et al. Intracranial vascular anomalies in patients with morning glory disk anomaly[J]. Am J Ophthalmol, 2006, 142(4): 644-650. DOI: 10.1016/j.ajo.2006.05.040.
19. Ganesh A, Mitra S, Koul RL, et al. The full spectrum of persistent fetal vasculature in Aicardi syndrome: an integrated interpretation of ocular malformation[J]. Br J Ophthalmol, 2000, 84(2): 227-228.
20. Cennamo G, de Crecchio G, Iaccarino G, et al. Evaluation of morning glory syndrome with spectral optical coherence tomography and echography[J]. Ophthalmology, 2010, 117(6): 1269-1273. DOI: 10.1016/j.ophtha.2009.10.045.
21. Ellika S, Robson CD, Heidary G, et al. Morning glory disc anomaly: characteristic MR imaging findings[J]. AJNR Am J Neuroradiol, 2013, 34(10): 2010-2014. DOI: 10.3174/ajnr.A3542.
22. Giuffrè G.Morning glory syndrome: clinical and electrofunctional study of three cases[J]. Br J Ophthalmol, 1986, 70(3): 229-236.
23. Chan RT, Chan HH, Collin HB.Morning glory syndrome[J]. Clin Exp Optom, 2002, 85(6): 383-388.
24. Heidary G. Congenital optic nerve anomalies and hereditary optic neuropathies[J]. J Pediatr Genet, 2014, 3(4): 271-280. DOI: 10.3233/PGE-14108.
25. Amador-Patarroyo MJ, Pérez-Rueda MA, Tellez CH.Congenital anomalies of the optic nerve[J]. Saudi J Ophthalmol, 2015, 29(1): 32-38. DOI: 10.1016/j.sjopt.2014.09.011.
26. Cavazos-Adame H, Olvera-Barrios A, Martinez-Lopez-Portillo A, et al. Morning glory disc anomaly: a report of a successfully treated case of functional amblyopia[J]. J Clin Diagn Res, 2015, 9(10): 1-3. DOI: 10.7860/JCDR/2015/15086.6695.
27. Loudot C, Fogliarini C, Baeteman C, et al. Rehabilitation on functional amblyopia in morning glory syndrome[J]. J Fr Ophtalmol, 2007, 30(10): 998-1001.
28. Ho CL, Wei LC.Rhegmatogenous retinal detachment in morning glory syndrome pathogenesis and treatment[J]. Int Ophthalmol, 2001, 24(1): 21-24.
29. Yamakiri K, Uemura A, Sakamoto T. Retinal detachment caused by a slitlike break within the excavated disc in morning glory syndrome[J]. Retina, 2004, 24(4): 652-653.
30. Ho TC, Tsai PC, Chen MS, et al. Optical coherence tomography in the detection of retinal break and management of retinal detachment in morning glory syndrome[J]. Acta Ophthalmol Scand, 2006, 84(2): 225-227.
31. Yang XL, Zhang X.Vitrectomy of rhegmatogenous retinal detachment in morning glory syndrome[J]. Int J Ophthalmol, 2010, 3(1): 89-91. DOI: 10.3980/j.issn.2222-3959.2010.01.21.
32. 童毓华, 马进, 张怡.玻璃体切割手术治疗伴黄斑裂孔及增生性视网膜脱离的小儿牵牛花综合征[J]. 中华眼底病杂志, 2013, 29(2): 206-208. DOI: 10.3760/cma.j.issn.1005-1015.2013.02.023.Tong YH, Ma J, Zhang Y.Vitrectomy for children morning glory syndrome with macular hole and poliferative retinal detachment [J]. Chin J Ocul Fundus Dis, 2013, 29(2): 206-208. DOI: 10.3760/cma.j.issn.1005-1015.2013.02.023.
33. Naseripour M, Ghasempour A, Falavarjani KG, et al. Perfluorocarbon liquid migration into the subarachnoid space in a patient with morning glory syndrome[J]. J Curr Ophthalmol, 2015, 27(1-2): 60-62. DOI: 10.1016/j.joco.2015.09.004.
34. Azuma N, Yamaguchi Y, Handa H, et al. Mutations of the PAX6 gene detected in patients with a variety of optic-nerve malformations[J]. Am J Hum Genet, 2003, 72(6): 1565-1570. DOI: 10.1086/375555.
35. Nallathambi J, Neethirajan G, Shashikant S, et al. PAX6 missense mutations associated in patients with optic nerve malformation[J]. Mol Vis, 2006, 12: 236-242.
36. Guerra-Junior G, Spinola-Castro AM, Siviero-Miachon AA, et al. Absence of mutations in Pax6 gene in three cases of morning glory syndrome associated with isolated growth hormone deficiency[J]. Arq Bras Endocrinol Metabol, 2008, 52(8): 1221-1227.
37. Cennamo G, Liguori G, Pezone A, et al. Morning glory syndrome associated with marked persistent hyperplastic primary vitreous and lens colobomas[J]. Br J Ophthalmol, 1989, 73(8): 684-686.
38. Pedler C.Unusual coloboma of the optic nerve entrance[J]. Br J Ophthalmol, 1961, 45(12): 803-807.
39. Dempster AG, Lee WR, Forrester JV, et al. The 'morning glory syndrome' - a mesodermal defect?[J]. Ophthalmologica, 1983, 187(4): 222-230.
40. Manschot WA.Morning glory syndrome: a histopathological study[J]. Br J Ophthalmol, 1990, 74(1): 56-58.
41. Irvine AR, Crawford JB, Sullivan JH.The pathogenesis of retinal detachment with morning glory disc and optic pit[J]. Retina, 1986, 6(3): 146-150.
42. Nagasawa T, Mitamura Y, Katome T, et al. Swept-source optical coherence tomographic findings in morning glory syndrome[J]. Retina, 2014, 34(1): 206-208. DOI: 10.1097/IAE.0b013e318296575c.

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