Contractile movement and Fibrin sealant in Vitrectomy of a Morning Glory Disc Retinal Detachment

Author: Wei Wei LEE (Canada)

Co-authors: Peter Kertes

Purpose

We present a novel surgical approach of vitrectomy and fibrin sealant with silicone oil endotamponade for the treatment of a recurrent retinal detachment in a child with morning glory disc anomaly. We captured the contractile movement which is a rare entity of morning glory disc.

Setting/Venue

The Hospital for Sick Children, Toronto, Canada.

Methods

Management of retinal detachment associated with morning glory disc anomaly remains a challenge. We present a case of a 10-year-old boy with a recurrent morning glory detachment capturing the contractile movement and presenting a novel surgical approach. He had an initial failed surgery with vitrectomy and long-acting gas tamponade. At his first surgery, we performed a standard 23G pars plana vitrectomy and fundus examination with 360 scleral depression revealed no other retinal breaks. Air-fluid exchange was performed, and laser applied around the morning glory disc. Fibrin sealant was injected over the morning glory disc and 18% perfluoropropane was used as endotamponade. Retina was briefly attached post-operatively but redetached at Month 1 after surgery with extensive proliferative vitreoretinopathy. He underwent another vitrectomy and fibrin sealant glue remained in-situ plugging the disc. PVR membranes removed with an intraocular forcep and retina was flattened under air-fluid exchange. Silicone oil was injected to tamponade the retina.

Results

Patient achieved complete retinal reattachment and remained attached at 6 months follow-up.

Conlusions

Morning glory disc associated rhegmatogenous retinal detachment is difficult to repair because retinal breaks are not easily detected. Communication between the subarachnoid space and vitreous cavity have been proved clinically in patients with the morning glory anomaly and there have been reported cases of silicone oil migration from the eye into the intraventricular space. This case demonstrated that fibrin sealant can be a useful adjunct in vitrectomy for repair of retinal detachment related to morning glory syndrome as a plug for sealing retinal breaks and to better allow the surface tension of the silicone oil to keep the retina attached and hopefully also to prevent migration of silicone oil, to achieve successful anatomical reattachment.

Financial Disclosure

None