Outcomes of Nd:YAG laser treatment for Valsalva retinopathy due to intense military exercise

VALSALVA RETINOPATHY: Clinical Features and Treatment Outcomes

PURPOSE

To report the clinical presentation and outcomes in patients with Valsalva retinopathy.

METHODS

This was a retrospective case series of patients diagnosed with Valsalva retinopathy between June 1, 2010, and May 31, 2020. Clinical notes, operative reports, fundus photography, and optical coherence tomography images were reviewed.

RESULTS

This study comprised 58 eyes of 58 patients. The most common causes were lifting (34.4%), vomiting (20.6%), straining (20.6%), and coughing (17.2%). Mean best-corrected visual acuity at diagnosis was 20/163. The most frequently involved vitreoretinal compartment was the subhyaloid space (42.3%) followed by the intraretinal (32.7%), intravitreal (23.1%), and subretinal (13.4%) spaces. Mean best-corrected visual acuity of all patients was 20/59 at 3 months, 20/48 at 6 months, and 20/22 at 1 year. Mean time to clearance of hemorrhage on clinical examination was 99.0 ± 18.7 days in patients who underwent observation and 4.5 ± 3.5 days after surgery in patients who received pars plana vitrectomy.

CONCLUSION

Valsalva retinopathy is generally associated with a favorable visual prognosis. Most eyes perform well with observation although pars plana vitrectomy may be indicated in patients requiring rapid resolution of hemorrhage.

Postcoital visual loss due to valsalva retinopathy: A case report

Valsalva retinopathy is a rare pathology presenting as a sudden and painless loss of vision affecting young subjects with no medical history. It is the result of an increase of intraocular venous pressure, leading to retrohyaloid haemorrhage.

We describe here the clinical presentation of a retrohyaloid hemorrhage resulting from a valsalva mechanism following a sexual activity, in a 28-year-old patient treated by Neodymium:yttrium-aluminum-garnet (Nd:YAG) laser hyaloidotomy with a visual recovery of 20/20 on 3 weeks follow-up.

Valsalva retinopathy is a rare and an easy-to-diagnose pathology that is safely handled by Nd:YAG laser hyaloidotomy for a quick visual acuity recovery.

•

Report a case of a valsalva retinopathy occuring in a young healthy adult following a sexual activity.

•

Develop our personal experience and how we managed to jugulate the hemorrhage by a Nd-yag laser membranotomy.

•

Describe the mechanisms leading to Valsalva retinopathy and its management by a Nd-yag laser membranotomy.

Full Thickness Retinal Hole Formation after Nd:YAG Laser Hyaloidotomy in a Case with Valsalva Retinopathy

A 27-year-old male was presented with a sudden onset of visual loss in his right eye. A secondary care center referred the patient with fundus photographs which were screened 4 days before and after the Nd: YAG laser hyaloidotomy treatment. Snellen acuity was 10/10 in both eyes. Fundus examinations revealed a retinal pigment epithelium (RPE) alteration at the margin of the inferior temporal arterial vascular arcade in the right eye and resolved preretinal and subretinal hemorrhages were seen in the macula. A diagnosis of Valsalva retinopathy was made based on the history and the treatment photographs of Nd:YAG laser hyaloidotomy. At 1st month examination all hemorrhages were resolved but RPE alterations were still at the margin of the inferior temporal arterial vascular arcade. The optical coherence tomography angiography (OCTA) images revealed 2 lesions. On en face OCT angiogram of OCTA full thickness retinal hole formation and ellipsoid zone damage at the superior and inferior margin of the inferior temporal arterial vascular arcade were seen. Superficial vascular plexus was also damaged at that region. The projection of the evacuation of blood from subhyaloid space and the full thickness retinal hole formation were the same, indicating that the partial and full thickness retinal holes were created by the laser treatment.

Treatment of Valsalva retinopathy

PURPOSE

To report a case of Valsalva retinopathy treated by neodymium-doped yttrium aluminum garnet (Nd:YAG) laser and discuss the previously reported treatments for Valsalva retinopathy.

CASE REPORT

A 35-year-old-woman experienced a sudden painless visual loss in her left eye after lifting heavy bags of manure on the farm. The patient was diagnosed as having Valsalva retinopathy. The examination revealed a macular preretinal hemorrhage. An Nd:YAG laser was used on the patient after conservative management afforded no resolution. After treatment, visual acuity improved.

CONCLUSIONS

Valsalva retinopathy can be treated by conservative management, Nd:YAG laser, and vitrectomy, but each treatment must be evaluated in regard to the duration, the location, and the amount of the hemorrhage.

Combine intravitreal bevacizumab with Nd: YAG laser hyaloidotomy for valsalva pre-macular haemorrhage and observe the internal limiting membrane changes: a spectralis study

Valsalva retinopathy was described as a particular form of retinopathy, pre-retinal and subinternal limiting membrane haemorrhages in nature that rarely may break through and become subhyloid or intravitreal, secondary to a sudden increase in intrathoracic pressure. We reported a new way that Nd:YAG laser for ILM hyaloidotomy in order to drain the sub-ILM blood into vitreous cavity combined with intravitreal bevacizumab to improve the absorption of blood. Therapeutic alliance make significant outcome, protecting vision in time. We used spectralis OCT to observe sub-ILM mix cells and special ILM structure in this lesion for the first time, as the spectralis OCT can reach histology level imagination.

[Early treatment with Nd:YAG laser for Valsalva retinopathy: results of five cases and literature review]

INTRODUCTION

According to the literature, the treatment of retinopathy of Valsalva (VR) by laser is recommended when the macular hemorrhage has not regressed after 3 weeks.

PATIENTS AND METHODS

We report five cases of VR treated early (≤ 24 hours) by Nd:YAG laser membranotomy (LM). Clinical examination was performed before and after LM (D1, D7, M1, M3 and M6). Optical coherence tomography (OCT) analysis was performed to determine the precise location of the macular hemorrhage.

RESULTS

Good visual recovery was obtained early by LM with a stable outcome at 6 months. The hemorrhage was located under the internal limiting membrane (ILM) and posterior hyaloid in two patients and only under the ILM in three patients.

DISCUSSION

The literature review and our study confirm the good functional results for patients treated by LM for VR. Furthermore, very few side effects are reported with this type of treatment compared with the natural course of the disease, which may certainly regress spontaneously, but carries a risk of secondary preretinal fibrosis. However, to obtain optimal efficacy, the treatment should be carried out as soon as possible, in order to avoid clotting of the hematoma, preventing any subsequent evacuation by laser.

CONCLUSION

LM for VR is an effective, safe and inexpensive technique compared to the surgical management of these patients presenting with a persistant premacular hematoma after a period of observation.