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Introduction: The aim of this study was to present the clinical presentation and short-term outcomes of uncomplicated rhegmatogenous retinal detachment managed by pneumatic retinopexy at a tertiary eye hospital in western Saudi Arabia. Materials and methods: This one-armed retrospective cohort study evaluated selected cases of rhegmatogenous retinal detachment managed by pneumatic retinopexy between 2017 and 2018. Data were collected on patient demographics, preoperative ophthalmic assessment, surgical details, follow up at six months postoperatively, complications and the need for additional surgery. Anatomic success was defined as retinal attachment at 6 months and functional success was defined as vision >20/200 at six months postoperatively. The association of lens status and concomitant laser treatment to anatomical success rates were evaluated. Results: The study sample consisted of 15 eyes with rhegmatogenous retinal detachment in the upper quadrant. In 14 cases, C3F8 gas was used. Anatomic and functional success was noted in 73.3% [95% confidence interval (CI) 51.0: 95.7] and 86.7% (95% CI 69.2; 100) of eyes, respectively. The association between anatomical success and lens status was not significant [RR = 4.5 (95% CI 0.6 ; 37.5), P=0.1]. There was no significant association between anatomical success and concomitant laser treatment. [RR = RR = 1.7 (95% CI 0.7 ; 4.0), P=0.2]. A 2nd retinal surgery was not required in 33.3% of eyes (95% CI 9.5 ; 57.2). Conclusion: If stringent selection criteria are used for managing rhegmatogenous retinal detachment with pneumatic retinopexy, anatomical and functional success by six months postoperatively is achieved in the majority of cases. Additional surgeries could further improve outcomes.

Key Clinical Message Pediatric emergency visits with purpura fulminans should raise the suspicion of hereditary homozygous protein C deficiency even beyond the neonatal age. The absence of this classical finding does not role the diagnosis out as atypical presentation with isolated intraocular bleeding was observed. Premarital counseling should be offered when family history suggests.

Introduction: Peters anomaly is a rare developmental malformation involving the anterior segment of the eye, which culminates in amblyopia or congenital blindness. Multiple ocular and/or systemic malformations have been observed with this anomaly, and novel comorbidities continue to be reported. Case Presentation: The probands were monozygotic twin boys (twin I and twin II) born to consanguineous parents at 36 weeks of gestation. Coarse facial features and deep-seated eyes were noted at birth. At 6 months, ophthalmic examination revealed that both twins were unable to blink in response to light, or to fixate and follow a moving object. Both twins had prominent horizontal nystagmus. Slit-lamp examination demonstrated varying degrees of central leukoma (corneal opacity) associated with iridocorneal adhesion, which is characteristic of type I Peters anomaly. No cataractous changes were observed. Normal intraocular pressure and disorganized retina were observed. Pupillary abnormalities included bilaterally underdeveloped pupils and bilateral absence of pupils was noted. Ocular MRI showed bilateral microphthalmia and optic nerve hypoplasia, with a small optic chiasm in both twins. At this age, the diagnosis of Peters anomaly was made. At 16 months of age, both twins developed deep venous thrombosis and purpuric skin lesions. Investigations revealed a hereditary thrombophilia secondary to a homozygous mutation causing protein C deficiency, which is a rare thrombotic condition. Ocular ultrasonography revealed bilateral vitreous hemorrhaging linked to altered coagulation. One twin developed bilateral inguinal hernia and cryptorchidism. Conclusion: The novel concordance of Peters anomaly in these monozygotic twins sharing a mutation in PROC gene provides further evidence that this anomaly has a genetic basis. Hypoplasia of the optic nerves and optic chiasm, along with severe protein C deficiency and bilateral absence of the pupils, are associated comorbidities that have not previously been reported with this anomaly.

Sub-internal limiting membrane (sub-ILM) hemorrhage is a distinct type of retinal hemorrhage in which the blood accumulates between ILM and nerve fiber layer. Little is known about visual prognosis as well as ideal management of foveal sub-ILM hemorrhage in patients with acute leukemia. Herein, we presented a case of acute myeloid leukemia with foveal sub-ILM hemorrhage. Observation alone resulted in complete resolution of hemorrhage with good visual and anatomical outcome.