Pars plana vitrectomy for valsalva retinopathy: a case series

Purpose To investigate the utility of pars plana vitrectomy in a series of patients with Valsalva retinopathy. Methods A retrospective, case series study that includes five patients with sudden visual acuity loss owing to Valsalva retinopathy with too dense premacular hemorrhages, treated in our hospital in the last three years. The etiology of the premacular hemorrhage was: vomiting (cases 1, 2 and 3), trauma (case 4) and vigorous dancing (case 5). Mean age was 33±19 years. After a period of observation ranging between three and four weeks, all patients underwent 23-gauge pars plana vitrectomy. The internal limiting membrane (ILM) was released and the hemorrhage was cleaned.The sub-ILM localization was confirmed in all cases during vitrectomy. One patient suffered an accidental break during peribulbar anaesthesia which was resolved successfully with laser photocoagulation. Full clinical examination including best-corrected visual acuity (BCVA) (Snellen chart), intraocular pressure, fundus examination, and Optical Coherence Tomography (OCT) was performed at baseline and at last examination in all patients. The mean follow-up was 16.1 (3-32) months. Results BCVA was 10/10 in all patients one month after surgery and it remained unchanged during the follow-up period. Funduscopy appearance was excellent in all eyes. No postoperative complications were found. Conclusion Valsalva retinopathy is a very rare condition that causes sudden visual acuity loss. In those cases with too dense hemorrhages it is necessary to perform vitrectomy, with excellent visual outcomes, as these hemorrhages are highly unlikely to resolve spontaneously.