Spontaneous Closure of a Macular Hole After Nd:YAG Laser Treatment for Valsalva Retinopathy in Pregnancy

Tian, Zhongxu; Li, Haoyu; Zhu, Yaqin; Jin, Xiaohong; Li, Yumin; Li, Xian; Li, Jiuke

doi:10.1001/jamaophthalmol.2021.1619

Cited by 2 publications

(1 citation statement)

References 5 publications

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“…If conservative therapy is not optimal (e.g., massive hemorrhage in the macula, especially subretinal hemorrhage), other therapeutic choices should be considered. These include Nd:YAG laser membranotomy and pars plana vitrectomy [3,30]. Nd:YAG (pulse/Q-switched/frequency-doubled) krypton laser membranotomy can be used for a large subhyaloid/sub-ILM hemorrhage that is located at the macula and is at least 3 disc diameters in size [5,20,31,32].…”

Section: Treatmentmentioning

confidence: 99%

A brief review of Valsalva retinopathy

Asteris¹,

Kalogeropoulos²,

Moussa³

et al. 2022

Med Hypothesis Discov Innov Optom

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Background: Valsalva retinopathy is a specific type of retinopathy that appears following an acute rise in intrathoracic or intra-abdominal pressure. This review focuses on current literature and future directions for the diagnosis and management of Valsalva retinopathy. Methods: In this brief review, the literature was searched to provide an extensive general and updated description of Valsalva retinopathy, focusing on its management and prognosis. Selected articles are summarized to present the etiology, general pathology, pathophysiology, symptoms, signs, diagnosis, differential diagnosis, treatment, and prognosis of Valsalva retinopathy. Results: The main symptom of Valsalva retinopathy is loss of visual acuity following exertion. This is caused by the rupture of small superficial vessels in the macula and perimacular areas, leading to extravasation of blood. No link between age, sex, or race has been found, although fundus vessel abnormalities pose some predisposition to the disease. During fundoscopy, Valsalva retinopathy appears most frequently as well-defined preretinal hemorrhages confined to the sub-internal limiting membrane (ILM) or subhyaloid space. If ILM rupture occurs, hyaloid hemorrhage can appear. Diagnosis is based on the patient’s medical history and a standard examination. Usually, only observation of the patient is required, with the hemorrhage resolving within weeks to months. In cases of large premacular hemorrhage or large sub-ILM/subhyaloid hemorrhage, vitrectomy or Nd:YAG krypton laser membranotomy can be performed. Conclusions: Of all the aspects of Valsalva retinopathy that might trouble the physician, the most challenging features are differential diagnosis and the choice of optimal treatment. Therapeutic strategies for Valsalva retinopathy can be either conservative or based on Nd:YAG laser membranotomy and/or vitrectomy. All methods seem to have good outcomes. However, physicians should not be afraid of advancing beyond conservative therapy, especially in the event of persistent premacular hemorrhage, which could lead to permanent retinal damage if valuable time is lost, even after vitrectomy.

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Section: Treatmentmentioning

confidence: 99%

A brief review of Valsalva retinopathy

Asteris¹,

Kalogeropoulos²,

Moussa³

et al. 2022

Med Hypothesis Discov Innov Optom

View full text Add to dashboard Cite

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Surgical management of full-thickness macular hole following Nd:YAG laser hyaloidotomy for pre-macular haemorrhage in a patient with anaemic retinopathy

et al. 2022

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Pre-macular haemorrhage (PMH) can cause profound visual loss. Some surgeons prefer neodymium-doped yttrium aluminium garnet (Nd:YAG) hyaloidotomy as the first line of treatment due to being an easy technique and having a high success rate. However, the use of high energy close to the fovea can lead to various macular complications. We present a case of a patient who presented with PMH secondary to anaemic retinopathy. He underwent Nd:YAG laser hyaloidotomy, but developed a full-thickness macular hole. He further underwent vitrectomy and a type 1 closure was achieved. However, the visual gain was poor due to the large hole size and the collateral thermal damage. The hole may not close spontaneously, thus requiring surgical intervention. The surgical outcome of these holes depends on the size of the hole and the collateral thermal damage caused during the laser procedure.

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Spontaneous Closure of a Macular Hole After Nd:YAG Laser Treatment for Valsalva Retinopathy in Pregnancy

Cited by 2 publications

References 5 publications

A brief review of Valsalva retinopathy

A brief review of Valsalva retinopathy

Surgical management of full-thickness macular hole following Nd:YAG laser hyaloidotomy for pre-macular haemorrhage in a patient with anaemic retinopathy

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