Macular Hole Formation after Pars Plana Vitrectomy for the Treatment of Valsalva Retinopathy: A Case Report

We report a case of complete surgical resolution of Valsalva retinopathy that manifested as a premacular hemorrhage involving a membrane followed by a macular hole (MH) resulting from the first vitrectomy. A 20-year-old female patient was referred to our hospital due to sudden vision loss in the left eye. Her best-corrected visual acuity (BCVA) in the left eye was hand motion. Fundus photographs and optical coherence tomography (OCT) revealed a premacular hemorrhage. Nine weeks later, the BCVA in the left eye had returned to 20 / 100 and the premacular hemorrhage had completely resolved, but residual sub-internal limiting membrane deposits and a preretinal membrane were present. The preretinal membrane was removed by core vitrectomy and preretinal membrane peeling, but the foveal deposits could not be excised. Two weeks after the first vitrectomy, the deposits resolved spontaneously, but a full-thickness MH was present. Six months after a second vitrectomy with fluid-gas exchange, the BCVA in the left eye had improved to 20 / 25 and OCT showed that the MH had closed. This case illustrates the possibility of MH formation following vitrectomy for Valsalva retinopathy.

Macular Hole Formation after Pars Plana Vitrectomy for the Treatment of Valsalva Retinopathy: A Case Report

We report a case of complete surgical resolution of Valsalva retinopathy that manifested as a premacular hemorrhage involving a membrane followed by a macular hole (MH) resulting from the first vitrectomy. A 20-year-old female patient was referred to our hospital due to sudden vision loss in the left eye. Her best-corrected visual acuity (BCVA) in the left eye was hand motion. Fundus photographs and optical coherence tomography (OCT) revealed a premacular hemorrhage. Nine weeks later, the BCVA in the left eye had returned to 20 / 100 and the premacular hemorrhage had completely resolved, but residual sub-internal limiting membrane deposits and a preretinal membrane were present. The preretinal membrane was removed by core vitrectomy and preretinal membrane peeling, but the foveal deposits could not be excised. Two weeks after the first vitrectomy, the deposits resolved spontaneously, but a full-thickness MH was present. Six months after a second vitrectomy with fluid-gas exchange, the BCVA in the left eye had improved to 20 / 25 and OCT showed that the MH had closed. This case illustrates the possibility of MH formation following vitrectomy for Valsalva retinopathy.

Sudden visual loss after football game: a case report / 国际眼科杂志(Guoji Yanke Zazhi)

We describe a 27-year-old gentleman who presented with sudden loss of left vision after a football match. As there was no improvement with previous treatment, he was referred to us for second opinion three weeks after initial presentation. Examination showed a quiet left eye with large whitish lesion with fluid level in the macula. It posed a dilemma in diagnosis as possibility of infectious cause could not be ruled out.Pars plana vitrectomy with vitreous biopsy was done and it showed old organised blood from premacular haemorrhage resulted from valsalva retinopathy.

Valsalva Retinopathy Associated With an Oratorical Contest

A 17-year-old man presented to us with a chief complaint of decreased visual acuity accompanied by central scotoma. There was nothing unusual in his medical history other than a recent oratorical contest. At the time of initial diagnosis, the corrected visual acuity was 20/20 in the right eye and 20/100 in the left eye. No significant findings were apparent on ophthalmic evaluation. On fundoscopy, there was a dumbbell-shaped macular bleed with a well-defined margin in the left eye. The clinical course was closely monitored along with drug therapy. Four weeks post presentation, the pre-retinal hemorrhage had nearly resolved. On fluorescein angiography, no significant findings were observed. In the left eye, the corrected visual acuity had improved to 20/25. Valsalva retinopathy is a pathology that occurs when a sudden increase in intra-thoracic pressure or abdominal pressure occurs in an otherwise healthy person. Here we report a case of Valsalva retinopathy occurring following an oratorical contest along with a review of the relevant literature.

Valsalva retinopathy during end stage labour:considerations for treatment (a case report) / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To discuss the options for treatment (conservative versus surgical) in cases of Valsalva Retinopathy, reported during pregnancy.METHODS:We report the case of a healthy pregnant woman, who developed a dense premacular subhyaloid haemorrhage, in the right eye following a normal spontaneous vaginal delivery. She was managed conservatively.RESULTS: At 3 weeks the haemorrhage had contracted and the vision was HM but by the 6th month, the haemorrhage had resolved and vision returned to 6/5 in the right eye.CONCLUSION: Most cases of Valsalva retinopathy resolve spontaneously. Authors have shown the beneficial effect of Nd:YAG membranotomy of the internal limiting membrane.Early vitrectorny has also been advocated, as it delaminates the membrane which can act a scaffold for neovascularization.

A Case of Valsalva Retinopathy Associated with Straining at Stool / 영남의대학술지

The Valsalva maneuver is described as an expiratory effort against a closed glottis or airway. It leads to elevation of retinal venous pressure and may result in retinal hemorrhage. A fifty two-year-old man presented with an acute reduction of central visual acuity in his right eye which occurred after considerable straining at stool. Detailed past medical history revealed that he suffered from chronic constipation and hypertension. There were one disc sized subhyaloid hemorrhage and three small intraretinal hemorrhages around the fovea at the dilated fundus examination. After three months of follow-up without any treatment, the retinal hemorrhages resolved without any sequelae. Here we report a patient with sudden visual loss and retinal hemorrhage.

A Case of Atypical Valsalva Retinopathy after Strenuous Exercise

PURPOSE: To report a case of recurrent bilateral preretinal hemorrhages in a healthy male with no previous history of systemic or ocular diseases and to review the relevant literature. METHODS: History taking, measurement of visual acuity and intraocular pressure, slit-lamp examination, fundoscopy, and fluorescein angiography were performed in a 15-year-old male who had experienced a sudden decrease in visual acuity in both eyes after a couple of strenuous exercises in school. RESULTS: Best-corrected visual acuity (BCVA) was 0.9 in the right eye and 0.2 in the left, and bilateral premacular hemorrhages were observed. Most of the preretinal hemorrhages were completely resolved by the sixth week and visual acuity in the left eye improved to 0.6. Nine months after the initial event, preretinal hemorrhages recurred bilaterally, worse in the left eye, and BCVA decreased to 0.3 in the right eye and 0.02 in the left eye. We performed Nd: YAG laser disruption of the internal limiting membrane in the left eye. Four weeks after the procedure, most of the preretinal hemorrhages were resolved and visual acuity in the left eye improved to 0.2. CONCLUSIONS: Clinical improvement was achieved after Nd: YAG laser disruption of the internal limiting membrane in a case of recurrent bilateral preretinal hemorrhages.

A Case of Recurrent Valsalva Retinopathy Associated with Exercising a Barbell

PURPOSE: To report one case of recurrent Valsalva retinopathy presented as subretinal hemorrhage associated with exercising a barbell in a healthy man. METHODS: A 47-year-old healthy man visited our hospital complaining of a pericentral blind-spot in the right visual field. At first visit, visual acuity was 20/20 without correction. Anterior segment examination was unremarkable and dilated fundus examination revealed a subretinal hemorrhage in the inferior area of the macula. We followed up the visual acuity, anterior segment exam, fundus examination, and fluorescein angiography for several weeks. RESULTS: Three weeks after the first visit, the size of subretinal hemorrhage decreased, but recurrent subretinal hemorrhage presented after exercising a barbell at the existing hemorrhagic part and its inferior area. Six weeks after the recurrent hemorrhage, the hemorrhage was resolved completely and the pericentral blind-spot was recovered. CONCLUSIONS: Valsalva hemorrhagic retinopathy is characterised by retinal hemorrhage occurring in healthy individuals due to a rapid rise in intrathoracic or intra-abdominal pressure. In this case, there was recurrent subretinal hemorrhage after repeatedly exercising a barbell. So, it is very important to educate patients about the restriction of excessive Valsalva maneuver to prevent recurrent Valsalva retinopathy.

A Case of Valsalva Retinopathy following Normal Delivery

PURPOSE: We report a case of Valsalva retinopathy following normal delivery. METHODS: A 32-year-old woman presented with visual blurring in her right eye which had developed on the previous day. At the first visit, visual acuity was 0.02 with correction. Anterior segment examination was unremarkable and dilated fundus examination revealed a dumbbell-shaped preretinal hemorrhage in the macula. Preretinal hemorrhage was a well-demarcated, red-colored subinternal limiting membrane hemorrhage. Fluorescein angiography demonstrated blocked fluorescence due to hemorrhage. The patient was followed up for two years. RESULTS: Two weeks after the first visit, the size of the preretinal hemorrhage decreased. Three weeks after the first visit, there was marked resolution of the hemorrhage with yellowish degeneration, but visual acuity did not improve. Six weeks after the first visit, the preretinal hemorrhage was resolved completely and visual acuity returned to normal with no specific treatment.

Valsalva Retinopathy Associated with Blowing up of a Rubber Glove

PURPOSE: Valsalva retinopathy is very uncommon disease, but can cause sudden reduction of visual acuity by unilateral macular hemorrhage due to a rapid rise in intrathoracic or intraabdominal pressure. It resolves usually within 1-3 months without specific treatment. We report a case associated with blowing up of a rubber glove. METHODS: A healthy young adult with normal visual acuity experienced visual blurring in one eye. At first visit, visual acuity was 0.06 with correction. Anterior segment examination was unremarkable and dilated fundus examination revealed a dumbbell-shaped preretinal hemorrhage in the macula. Preretinal hemorrhage was a well-demarcated, red-colored subinternal limiting membrane hemorrhage. Fluorescein angiography demonstrated blocked fluorescence due to hemorrhage. The patient was followed up. RESULT: Two weeks after first visit, the size of preretinal hemorrhage decreased. Three weeks after first visit, there was marked resolution of the hemorrhage with yellowish degeneration, but visual acuity was not improved. Six weeks after first visit, the preretinal hemorrhage resolved completely and visual acuity returned to normal. DISCUSSION: Valsalva retinopathy associated with blowing up of a rubber glove resolved within 6 weeks without no specific treatment.