Sir,

We report a case of morning glory optic disc with serous macular detachment in the left eye. The patient was treated with oral acetazolamide and followed up for a period of 3 years.

Case report

A 27-year-old lady presented in 2006 with onset of distortion in her left eye. Her visual acuity was 6/36 with a morning glory disc anomaly (Figure 1) and serous macular detachment (Figure 3). The central foveal thickness (CFT) was 928 μm in the left eye at baseline. With 1 month of oral slow-release acetazolamide 250 mg (Diamox) twice a day, her visual acuity improved to 6/18 and CFT was reduced to 553 μm. The dosage of acetazolamide was gradually tapered to 62.5 mg once a day over a period of 7 months. Her visual acuity improved to 6/9 in the left eye and CFT reduced to 241 μm in the left eye at the end of 12 months (Figures 2 and 3; Table 1)

Figure 1
figure 1

Left eye morning glory optic disc anomaly.

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Figure 3
figure 3

OCT (stratus 2) images in time order.

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Figure 2
figure 2

Response of central foveal thickness to oral acetazolamide.

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Table 1 Visual acuity and CFT response to oral acetazolamide
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Rebound serous detachment and recurrence of symptoms appeared on stopping oral acetazolamide.1 Symptoms of distortion and scotoma recurred. Visual acuity dropped to 6/60 in the left eye and CFT increased to 736 μm. There was no response to topical carbonic anhydrase inhibitors. She was recommenced on oral acetazolamide 125 mg once a day and her visual acuity was stable at 6/24 and CFT was 360 μm in the left eye when last reviewed (Figure 2; Table 1).

Comment

To the best of our knowledge, treatment of serous retinal detachment in morning glory syndrome2 with acetazolamide has not been previously reported. Improvement in visual acuity and significant reduction in CFT with a low dose of acetazolamide was observed in this case. Acetazolamide increases the pump activity of the retinal pigment epithelium and this is presumably the mechanism of action in this case.3, 4 Such cases are difficult to treat surgically.2, 5 Therefore, this report illustrates a novel alternative management approach.