Valsalva Retinopathy, Etiology, Treatment and Results

Valsalva Retinopathy, Etiology, Treatment and Results

J. Castro-Navarro, C. González-Castaño, M. García-Fernández, A. García-Alonso, M. Fonollá-Gil (Oviedo, Spain)

Purpose:

To report the etiology, treatment and results of six patients with Valsalva retinopathy.

Methods:

Six patients with sudden visual acuity loss owing to Valsalva retinopathy, treated in our hospital in the last three years, were selected for this study. Two patients underwent 20-G vitrectomy, three patients were treated with 23-G vitrectomy and in one patient it was not necessary the treatment because the hemorrhage was small and resolved spontaneously after one month. The causes of the premacular hemorrhage were as described in the following: Vomiting in 3 cases, one spontaneously, one during pregnancy and another after a general anesthesia for lipoma surgery, thoracoabdominal trauma in one case, dance in one case and weight lifting in one case. The mean age of the six patients was 33 years. Two patients, previously to the surgery, were treated with YAG laser without success. Full clinical examination including best-corrected visual acuity (Snellen), intraocular pressure, fundus examination and photography, and optical coherence tomography was performed prior to the intervention, in the operated cases, and during the follow-up period. The mean follow-up was 16.1 months (3-32 months).

Effectiveness / Safety:

In four of the operated patients one week after the surgery the complete transparency of the structures was observed and visual acuity was 10/10 which remained stable during the follow-up period. In one of the operated patients it was necessary to apply argon laser and to fill the vitreous cavity with gas SF6 at the end of the surgery because a retinal break originated during peribulbar anesthesia. In one patient the hemorrhage was small and resolved without treatment in one month. In all operated patients the blood was located both subhyaloid and under internal limiting membrane.

Take home message:

Valsalva retinopathy is a rare condition that causes sudden visual acuity loss, when the hemorrhage is too dense it is necessary to perform a vitrectomy, but surgery is not free of risks.