Intraoperative optical coherence tomography assisted analysis of pars Plana vitrectomy for retinal detachment in morning glory syndrome: a case report

Abstract

BackgroundThe pathogenesis of non-rhegmatogenous retinal detachment (non-RRD) associated with morning glory syndrome (MGS) is not established, as well as best surgical approach to treat RD. Our purpose was to analyse intraoperative optical coherence tomography data (iOCT) in all steps of pars plana vitrectomy (PPV) for non-RRD in MGS, in order to follow pathophysiological aspects of the disease and to understand the tissues behaviour during surgical workflow.Case presentationIntraoperative spectral domain optical coherent tomography (iSD-OCT) assisted PPV using Rescan 700 (Carl Zeiss Meditech, Jena, Germany) with epiretinal membrane (ERM) and internal retinal membrane (ILM) peeling, and air endotamponade was performed on the only eye of a 21 years old female with non-RRD associated with MGS. BCVA, pre-, intra- and postoperative OCT were performed along with standard ocular examination. iOCT video and snapshots were analysed intra- and postoperatively using post-processing approach using graphic software. The progression of non-RRD resulted in best corrected visual acuity (BCVA) decrease from 0.8 to 0.2. Triamcinolone enhanced iOCT imaging revealed strong vitreous traction and adhesion above the macula and optic disc. Internal limiting membrane was peeled under iOCT control to prevent the peeling of inner layers of the retinal schisis. No retinal break was detected, and only air endotamponade was performed. The retina reattached during first 4 weeks of follow-up with gradual resolution of intraretinal- and subretinal fluid, and remained stable in 12 months. BCVA improved to 0.8.ConclusionBased on iSD-OCT findings we assume that non-RRD in this case of MGS is caused primarily by the vitreous traction with further possible formation of the retinal breaks. Retinal reattachment reached only with air endotamponade strongly advocates the tractional component of non-RRD and retinal schisis assotiated with MGS. Early PPV for central non-RRD and retinal schisis with the use of iOCT can be performed in more safe and controlled manner and has to be considered to reduce the risk of retinal break formation and to prevent the central vision loss.Electronic supplementary materialThe online version of this article (doi:10.1186/s12886-017-0533-0) contains supplementary material, which is available to authorized users.

What Is the Impact of Intraoperative Microscope-Integrated OCT in Ophthalmic Surgery? Relevant Applications and Outcomes. A Systematic Review

“…MI-OCT may also play a role in non-rhegmatogenous retinal detachment, as observed by Lytvynchuk et al in a patient with morning glory syndrome [ 82 ]. In this case, retinal reattachment was obtained only with air endotamponade, revealing strong vitreous adhesion and traction above the macula and the optic disc [ 82 ].…”

<p>Intraoperative Optical Coherence Tomography Guided Ocular Surgeries: Critical Analysis of Clinical Role and Future Perspectives</p>

“…The injected triamcinolone and indocyanine green were observed to have better discretion ability in the presence of iOCT; in addition, the added 3D reconstruction ability provides delicate information for completion of vitrectomy and prevention of inadvertent peeling of inner retinal layers in pathological conditions (contrast enhanced vitrectomy). 78,79 Similarly, following the clearing of preretinal hemorrhage and vitreous hemorrhage which often preclude preoperative foveal assessment, can now imaged intraoperatively for delicate foveal understandings. If pathologies are found, then instantaneous decisions can be made on an individual case basis along with en face images and iOCT features.…”

Microcornea, posterior megalolenticonus, persistent fetal vasculature, chorioretinal coloboma (MPPC) syndrome: Case series post vitrectomy

“… 2 , 4 , 7 Morning glory syndrome manifests with PFV and lens dislocation in association with an optic nerve coloboma. 13 We did not see by echography the megalolenticonus, but we evidenced a short stalk adhered to the posterior lens capsule (as opposed to a classical presentation with a large stalk) that, as described by Ranchod et al, is a highly suggestive clinical sign of megalolenticonus. 7 Also, the lens was inferiorly subluxated associated to the short PFV and had elongated ciliary processes.…”