Bilateral and multiple sub-internal limiting membrane hemorrhages in a familial retinal arteriolar tortuosity patient by Valsalva-like mechanism: an observational case report

Abstract

Background: Bilateral and multiple Valsalva-related sub-internal limiting membrane (ILM) hemorrhages in a familial retinal arteriolar tortuosity (FRAT) patient is rare, and we treated this patient by both observation and Neodymium yttrium aluminum garnet (Nd: YAG) laser membranotomy methods. Case presentation: A 13-year-old female student presented with sudden visual loss and central scotoma in both eyes after running 800 m at the school gym. The examination revealed six sub-ILM hemorrhages with the biggest hemorrhage measuring approximately 1.5-disc diameters (DD) in the right eye and two sub-ILM hemorrhages with the biggest one measuring 5.5 DD in the left eye. The patient was diagnosed as having Valsalva retinopathy associated with FRAT. Nd: YAG laser membranotomy was performed at the biggest hemorrhages and the rest hemorrhages were treated with observation in both eyes. The visual acuity recovered to 20/16 in the right eye and 20/20 in the left eye. Epiretinal membrane (ERM) formation was observed in the left eye. Conclusions: Nd: YAG laser could be considered for treating premacular hemorrhage in FRAT patient especially when a quick vision recovery was needed. This is the first reported case of a FRAT patient suffering from bilateral and multiple Valsalva-related sub-ILM hemorrhages which were treated by both observation and Nd: YAG laser treatment.

A case series from a single family of familial retinal arteriolar tortuosity with common history of sudden visual loss

“…In most cases as in the current case, the clinical picture improves without treatment, 2 , 11 , 13 , 14 but if the hemorrhages are bilateral or the visual loss is severe, treatment is considered. Chen et al 15 performed Nd:YAG laser membranotomy to treat sub-ILM hemorrhage at the macula in a patient with FRAT and reported that the treatment was effective when rapid visual recovery is needed due to bilateral sub-ILM hemorrhages at the macula.…”

Retinal arterial macroaneurysm rupture by Valsalva maneuver: a case report and literature review

“…It is quite common in daily life and typical activities such as coughing hard, vomiting, straining, constipation, and weightlifting can all lead to it [ 6 ]. The Valsalva maneuver can affect retinal arteries due to the sudden and violent fluctuation of blood pressure that occurs [ 7 ].…”