Nd:YAG laser hyaloidotomy in a case of Valsalva retinopathy with premacular hemorrhage

Abstract

Intraretinal, preretinal, and vitreous hemorrhages in Valsalva retinopathy result from retinal capillary rupture following sudden increased retinal venous pressure from a rise in intrathoracic or intraabdominal pressure. While preretinal hemorrhages may resolve on their own or may be treated with vitrectomy, we report a case of Valsalva retinopathy with a dense premacular hemorrhage which was successfully treated with Nd:YAG laser hyaloidotomy. A healthy 27-years-old man presented with sudden painless visual loss after heavy cement bag lifting. His visual acuity was count fingers in the affected eye. A dilated fundus examination revealed a large dome shaped preretinal hemorrhage. Nd:YAG laser hyaloidotomy was performed at the inferotemporal margin of the preretinal hemorrhage. Within two weeks, the visual acuity improved to 20/20 and there was near complete resolution of the preretinal hemorrhage. Non-visually-significant pigment epithelial injury was noted at the site of the laser application. Nd:YAG laser hyaloidotomy may be a safe and effective therapeutic option in select patients with Valsalva retinopathy with preretinal hemorrhage.