Valsalva retinopathy is a rare cause of preretinal hemorrhage. Typically, patients present with acute painless loss of vision after performing a Valsalvatype maneuver. Mechanistically, it is thought that an acute rise in intrathoracic/intraabdominal pressure from closure of the glotis leads to an intraoclular venous pressure increase and capillary rupture. The patient in this case provided a classic history of straining prior to the onset of symptoms (ie, coughing during asthma attack). Valsalva retinopathy has also been described following weight lifting, vomiting, sexual activity, end stage labor, blowing musical instruments, and compressive injuries.
CASE PRESENTATION This case is simple, but it is interesting to for the imaging tools used in our clinic. A 40-year-old presented with best-corrected visual acuity of 20/400 in his right eye and 20/20 in his left eye and no other signs or symptoms of significant nature, including normal intraocular pressure in both eyes. The patient had no history of diabetes, hypertension, or any other systemic disease. He was not taking aspirin or any anticoagulant therapy.
His color fundus photo revealed a large preretinal hemorrhage (Figure 1A). His indocyanine green (ICG) angiography (Figure 1C) enabled us to rule out microanuerism, polypoidal choroidal neovascularization, trauma, and choroidal melanoma, leaving us with the diagnosis of valsalva retinopathy.
Valsalva retinopathy can be followed or treated. We chose to use Nd:YAG laser for this patient, which emptied and dislocated the the blood into the vitreous gel 15 minutes after laser. Two days post-laser, the location of the blood is apparent in the spectral-domain optical coherence tomography (SD-OCT) on imaging with the SPECTRALIS (Heidelberg Engineering, Heidelberg, Germany). When comparing the fluorescein angiography from the patient from 15 days post-laser progressing to 2 months post-laser. to the SD-OCT scan, the location of the Nd:YAG laser is quite visible in the OCTs scans. Because the image can be taken at exactly the same point, the SPECTRALIS is useful in following this patient as he improves.
Note: The images from this case will appear in a paper that has been recently accepted and that is currently published online: Sabella P, Bottoni F, Staurenghi G. Spectral-domain OCT evaluation of Nd:YAG laser treatment for Valsalva retinopathy. Graefes Arch Clin Exp Ophthalmol. 2009 Dec 8. [Epub ahead of print].
Giovanni Staurenghi, MD, is with the Eye Clinic at Sacco Hospital, University of Milan, Italy. Dr. Staurenghi is a consultant to and a speaker for Heidelberg Engineering. He can be reached via e-mail at giovanni.staurenghi@unimi.it.
_1773249222.png?auto=compress,format&w=75)
