Valsalva retinopathy: Long-term results and management strategies

Abstract

Purpose: To investigate the long-term results and efficacy of the treatment modalities for preretinal hemorrhage due to valsalva retinopathy. Methods: Retrospective review was conducted on 24 eyes of 24 patients with valsalva retinopathy who were treated between 2004 and 2019. These patients were treated with Nd:YAG laser, argon laser and vitrectomy or were only observed. Nd:YAG laser hyaloidotomy was performed in 10 eyes, argon laser was applied to two of those following failed Nd:YAG laser, and vitrectomy was performed in one eye. A conservative approach was adopted in 13 eyes. Results: There were 15 females and nine males with mean age of 41.08 ± 12.72 (21–65) years. Mean follow-up period was 42.83 ± 23.78 (range: 12–116) months. Patients with hemorrhage size smaller than or equal to 4-disc diameter were observed for spontaneous resorption and achieved 20/20 visual acuity within 6 months. Visual acuity of all patients treated with Nd:YAG and/or argon laser, increased within the first week after the treatment. Vitrectomy was performed in only one patient with hemorrhage located away from macula. The good visual outcomes were achieved in all treatment modalities. Conclusions: Observation, Nd:YAG laser and argon laser seem to be safe and effective approaches for eyes with valsalva retinopathy. The size, volume and duration of hemorrhage are the most crucial factors for treatment choice, success and complications.

Inverse drainage Nd:YAG membranotomy for pre-macular hemorrhage

“…Celik Dulger et al reported that a PMH ≤1DD in size resolved spontaneously within 2–3 months, while hemorrhages 1–4DD in size took nearly 6 months for complete resolution. 10 While most authors prefer to manage PMH ≤3DD size conservatively, some prefer to treat even the smaller hemorrhages. 1–16…”

“…Pre-macular hemorrhage (PMH) is one of the rare causes of sudden painless profound visual loss. [1][2][3][4][5][6][7][8][9][10][11] It is associated with conditions like Valsalva retinopathy, retinal artery macroaneurysm (RAM), proliferative diabetic retinopathy, retinal vein occlusion (RVO), Terson's syndrome, and hematological disorders like aplastic anemia and leukemia. It presents as a circumscribed, boat-shaped, collection of blood located beneath the internal limiting membrane (ILM) and/ or between the ILM and the posterior hyaloid face.…”

“…It presents as a circumscribed, boat-shaped, collection of blood located beneath the internal limiting membrane (ILM) and/ or between the ILM and the posterior hyaloid face. [1][2][3][4][5][6][7][8][9][10][11] Although PMH undergoes spontaneous resolution, this may take weeks to months. This not only incapacitates the patients for a long period, but can also result in permanent visual damage due to epiretinal membrane (ERM) formation, pigmentary macular changes, and/ or toxic damage to the retina due to prolonged contact with hemoglobin and iron.…”

“…This not only incapacitates the patients for a long period, but can also result in permanent visual damage due to epiretinal membrane (ERM) formation, pigmentary macular changes, and/ or toxic damage to the retina due to prolonged contact with hemoglobin and iron. [1][2][3][4][5][6][7][8][9][10][11] Various modalities such as Neodymium-doped Yttrium Aluminum Garnet (Nd:YAG) laser membranotomy, pneumatic displacement, and pars plana vitrectomy (PPV) have been described for its treatment. [1][2][3][4][5][6][7][8][9][10][11] Nd:YAG laser membranotomy is the current gold standard of treatment.…”

Postcoital visual loss due to valsalva retinopathy: A case report

“…Although the hemorrhage may regress spontaneously, it exposes to a risk of secondary preretinal fibrosis [ 21 ]. A slowly resolving subhyaloid hemorrhage also prolongs the contact of the retina with hemoglobin and iron, potentially leading to toxic damage to the retina, which can cause permanent visual loss [ 22 ].…”