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Ultrasonographic Features of Morning Glory Syndrome and Peripapillary Staphyloma in Children: Associations With
Qian Yang1, Lu Ruan1, Meng Zhang1
1Department of Ophthalmology, Eye and Ear Nose Throat Hospital of Fudan University, Shanghai, China; Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China.
Purpose:
To characterize ultrasonographic features of morning glory syndrome (MGS) and peripapillary staphyloma (PS) in children and their associations with retinal detachment (RD).
Design:
Retrospective observational cohort study.
Subjects:
A diagnostic cohort of 83 eyes classified as MGS (53 eyes) or PS (30 eyes) and a full cohort of 231 eyes with congenital optic disc excavation after exclusion of optic disc coloboma and acquired causes.
Methods:
Clinical records and B-scan ultrasonography images of patients aged 18 years or younger were reviewed. The diagnostic cohort compared MGS and PS. In the full cohort, RD present at the initial examination (baseline RD) was the primary outcome; RD documented at baseline or follow-up was analyzed secondarily, and incident RD was analyzed separately among eyes without baseline RD with follow-up.
Main Outcome Measures:
Ultrasonographic differences between MGS and PS and associations of excavation depth and morphology with baseline RD. Secondary outcomes included incident RD and final best-corrected visual acuity (BCVA).
Results:
In the diagnostic cohort, MGS eyes had deeper excavation than PS eyes (4.08 ± 2.11 mm vs. 2.80 ± 1.22 mm; P < 0.001), and non-bowl-shaped excavation was more frequent in MGS (73.6% vs. 10.0%; P < 0.001). Final BCVA was available for 69 eyes and was worse in MGS than in PS (1.85 ± 0.81 vs. 1.35 ± 0.81 logMAR; P = 0.006). In the full cohort, 82 of 231 eyes had baseline RD. Greater excavation depth (adjusted OR, 1.25; 95% CI, 1.05-1.49; P = 0.013) and non-bowl-shaped morphology (adjusted OR, 7.18; 95% CI, 2.92-17.64; P < 0.001) were associated with baseline RD. Results were similar for RD documented at baseline or follow-up. Among 123 eyes included in the longitudinal analysis, ten developed incident RD. Greater excavation depth was associated with incident RD (HR, 1.30; 95% CI, 1.05-1.60; P = 0.014).
Conclusion:
MGS and PS have partially overlapping but distinguishable ultrasonographic features. Greater excavation depth and non-bowl-shaped morphology were associated with RD, while greater excavation depth was also associated with incident RD. B-scan ultrasonography provides reproducible structural information for distinguishing MGS from PS and characterizing excavation features associated with RD.
