Polypoidal choroidal vasculopathy: naked polyp.

We present an unusual case of polypoidal choroidal vasculopathy (PCV) lying above the retinal pigment epithelium (RPE) in a 60-year-old Caucasian female. PCV lesions are typically located beneath the RPE layer. However, they may rarely lie above the level of the RPE due to a discontinuity in the RPE and Bruch's membrane.

SCALP syndrome: What is it and its ophthalmic manifestations.

PURPOSE: To present the ophthalmic manifestations of a 3-month old female with SCALP syndrome. OBSERVATIONS: The patient presented with multiple ocular anomalies including bilateral limbal dermoids, esotropia and left optic nerve hypoplasia. CONCLUSIONS: We describe systemic and ocular anomalies in a rare case of SCALP syndrome. This report provides additional information on the ocular anomalies not previously described that may be associated with this clinical entity.

Parinaud syndrome: a 25-year (1991-2016) review of 40 consecutive adult cases.

PURPOSE: To characterize the clinical features, aetiology and management of ophthalmic symptoms in adult patients with Parinaud syndrome. METHODS: This is a retrospective, non-comparative observational case series. We reviewed 40 consecutive charts of adult patients with the clinical diagnosis of Parinaud syndrome at the Royal Adelaide Hospital Department of Ophthalmology in Adelaide, South Australia, between 1991 and 2016. Charts were reviewed for the following: (1) demographic information, (2) clinical presentation, (3) neuro-ophthalmology signs, (4) aetiology of Parinaud syndrome, and (5) management. Examination findings were collected at initial evaluation, throughout the course of follow-up, and at last follow-up. RESULTS: All the cases were assessed by one of the authors (JLC). The commonest presenting symptoms were diplopia (67.5%) and blurred vision (25%) followed by visual field defect (12.5%), ataxia (7.5%) and manifest squint (7.5%). The commonest presenting signs were vertical gaze palsy (100%), convergence-retraction nystagmus (87.5%) and light-near dissociation (65.0%). Only 65.0% patients had the classical triad of vertical gaze palsy, convergence-retraction nystagmus and light-near dissociation. Midbrain pathologies including haemorrhage (30.0%), infarction (20.0%) and tumour (15.0%) were the commonest aetiology. Pineal region tumours accounted for 30.0% of presentations. Symptoms were managed conservatively in 45% of cases with temporary occlusion, prisms or refractive correction, and observation in 42.5% of cases. Surgical intervention for refractory diplopia was required in 12.5% of cases, of which 80% reported symptom resolution following surgery. CONCLUSION: Our series highlights the variable clinical presentation of Parinaud syndrome. The classic triad of conjugate upgaze paralysis, convergence-retraction nystagmus and light-near dissociation was only present in 65% of cases. Pineal neoplasms remain an important aetiological consideration; however, primary midbrain pathology including infarction and haemorrhage constituted the majority of our cases and should be considered in all patients. Conservative management approaches for ocular symptoms are sufficient in most cases although surgical treatment of upgaze palsy can be a useful option in refractory cases.

Giant retinal tear after pneumatic retinopexy.

PURPOSE: To report a case with giant retinal tear after pneumatic retinopexy. To our knowledge, this is only the second case of a giant retinal tear after pneumatic retinopexy reported. METHODS: This is a descriptive case study. RESULTS: A 43-year-old myopic man underwent pneumatic retinopexy for right eye rhegmatogenous retinal detachment. Postoperative course was complicated by a giant retinal tear, which was treated successfully. CONCLUSION: Though rare, giant retinal tears can occur after pneumatic retinopexy. The likely mechanism is increased vitreous traction because of expansion of gas in a predisposed myopic eye.