Premacular Hemorrhage in Valsalva Retinopathy: A Study of 21 Cases

The objective of this study was to investigate the causes, the clinical presentation, and treatment modalities in patients with valsalva premacular hemorrhage. This case series study included 21 eyes of 21 patients referred to retina clinic of Farabi eye hospital and two private eye clinics during 2001-2006 with sudden loss of vision and clinical diagnosis of premacular hemorrhage due to valsalva retinopathy. Nd:YAG laser Hyaloidotomy was performed in 16 eyes with larger than 3 disc diameter (DD) hemorrhage in size and enough depth of hemorrhage pocket (dome-shaped) and conservative approach in 5 eyes with smaller than 3 DD in size. Main outcome measures including cause of valsalva premacular hemorrhage based on the history, success rate in performing hyaloidotomy, release of the entrapped blood into the vitreous cavity and the duration of its resorption, spontaneous resorption in observed cases, postoperative improvement in visual acuity (VA), additional intervention such as vitrectomy, and postoperative complications were recorded and analyzed. Premacular hemorrhage was a result of vigorous sexual activity in 10 patients (47.6%), heavy lifting in 2 (9.5%), end stage labor in 2 (9.5%), compressive trauma in 1 (4.7%), straining on toilet in 2 (9.5%), roller coaster riding in 1 (4.7%), sneezing in 1 (4.7%), and occurred during sleep or unknown in 1 (4.7%). Nd:YAG laser Hyaloidotomy was successful in (87.5%) of patients with large size hemorrhage and trapped blood was released in to vitreous cavity and absorbed within 6-23 (mean 14.5±5.1) days. In observed patients, spontaneous resorbtion of trapped blood was occurred within 21-83 (mean 47.2±22.8) days. No predisposing factor was seen in patients. During the follow-up of 38.47±19.2 months, an epiretinal membrane formation was seen in 1 eye. 85.7% of patients in laser group gained full vision. In our study, vigorous sexual activity was the most common cause of valsalva premacular hemorrhage. Nd:YAG laser Hyaloidotomy was a safe and simple procedure in patients with hemorrhage occupied more than 3 DD in size and enough depth of hemorrhage pocket (dome-shaped) and caused visual recovery in majority of patients.