Long-term evolution of Valsalva retinopathy: a case series

Abstract

IntroductionValsalva retinopathy may occur as a sudden, dramatic loss of central vision due to the premacular location of the haemorrhage. It has been described in different clinical settings, and there are several options for its treatment.Case presentationsWe present the cases of six patients with sudden visual acuity loss caused by Valsalva retinopathy, treated in our hospital in the last ten years. Case 1 involves a 32-year-old Caucasian man with a unilateral premacular haemorrhage after vomiting. A neodymium-doped yttrium aluminium garnet laser was used due to sufficient depth of the haemorrhage pocket, but it was unsuccessful. Instead, 20G pars plana vitrectomy was performed with excellent visual recuperation (visual acuity:1.0). Case 2 was of a 36-year-old Caucasian woman with Valsalva retinopathy after vomiting during pregnancy. A neodymium-doped yttrium aluminium garnet laser was also insufficient due to the coagulated blood. After labour, 23G pars plana vitrectomy was performed, and her final visual acuity was 1.0. Case 3 involved a 52-year-old Caucasian man with premacular bleeding due to vomiting after general anaesthesia. The haemorrhage did not resolve spontaneously, so 23G pars plana vitrectomy was performed, with excellent visual outcomes (visual acuity:1.0). Case 4 was a 24-year-old Caucasian man with a macular haemorrhage after thoracic trauma. He was observed over four weeks, after which we performed 23G pars plana vitrectomy, with complete visual restoration (visual acuity:1.0). Case 5 involved a 28-year-old man who developed a premacular bleed after vigorous dancing. After a period of observation, 23G pars plana vitrectomy was performed. A retinal break with a small haemorrhage around the break occurred, related to the peribulbar anaesthesia manoeuvers, but was resolved successfully. His final visual acuity was 1.0. Case 6 was a 22-year-old Caucasian woman who developed a premacular haemorrhage after weightlifting. Conservative management was performed due to the small size of her haemorrhage. It resolved spontaneously within one month, and her final visual acuity was 1.0.ConclusionValsalva retinopathy is a rare condition that causes a sudden loss of visual acuity. In patients with too dense haemorrhage, the best option could be the vitrectomy, with excellent visual outcomes, although surgery is not free of risks.

Treatment of Valsalva Retinopathy

“…Vitrectomy has been reported to be more effective and safer than other treatments in the management of patients with dense premacular hemorrhages and insufficient spontaneous reabsorption, 17 resulting in significant and immediate visual improvement. 18 There are, however, reports of the possibility of macular hole formation and cataract formation after treatment of Valsalva retinopathy using VTM.…”

Valsalva hemorrhagic retinopathy presenting as a rare cause of impaired vision after a general anesthetic—a case report and review of the literature

“…Neodymium-doped yttrium aluminum garnet laser membranotomy with drainage into the vitreous cavity or vitrectomy with membrane peeling can remove the preretinal hemorrhage [14,[24][25][26][27].…”

“…Valsalva hemorrhagic retinopathy occurs with many common and seemingly benign events, including the following: sneezing [28], coughing [29], coughing secondary to an asthma attack [30], vomiting [14,31,32], vomiting after anesthesia [14] and during pregnancy [14,33], normal labor [34], a speech contest [35], dancing [14,36,37], defecation [28], riding a roller coaster [28], blowing up of balloons [38] and rubber gloves [39], sexual activity [28,40], weightlifting for sport [14,[41][42][43] and other heavy lifting [28], pushups [44], military [25] and other vigorous exercise [45,46], motorcycle stunt riding [47], bungee jumping [48], intentional breath holding and choking [49], and compressive trauma [14,28].…”

“…Postoperative visual loss may occur after common interventions and has been previously reported after a number of seemingly benign and common anesthetic-related maneuvers [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19].…”

Rétinopathie De Valsalva Et Grossesse.

“…La grossesse est connue comme facteur de risque de cette affection. Le pronostic est en général bon avec une récupération spontanée dans la grande majorité des cas [4] [5]. Le moment de la résorption spontanée est très variable.…”