Valsalva Retinopathy Associated With a Congenital Retinal Macrovessel

Crecchio, Giuseppe de; Pacente, Luigi; Alfieri, M. C.; Greco, Giovanni

doi:10.1001/archopht.118.1.146

Cited by 15 publications

(13 citation statements)

References 4 publications

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“…These vessels also have a predilection for vascular occlusive disease 16. Although they do not normally stain with FA, there may be associated ischaemia, leakage, remodelling, and even preretinal neovascularization in the event of a trombotic occlusion 17 18. In our case, the peculiar segmental anomalous vascular lesion in the choroid showed no staining within its wall with either fluorescein or indocyanine-green; it demonstrated a choroidal-pigment epithelial proximity, with a tubular elevation of the retinal pigment epithelium and choroidal layers with point to point correlation on the SD-OCT.…”

Section: Discussionmentioning

confidence: 99%

Choroidal macrovessel

Lima

Laud

Chang

et al. 2010

British Journal of Ophthalmology

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Section: Discussionmentioning

confidence: 99%

Choroidal macrovessel

Lima

Laud

Chang

et al. 2010

British Journal of Ophthalmology

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“…FA findings of anomalous vessels consist of early filling and delayed emptying, capillary perfusion abnormalities, focal capillary dilatations, direct arteriovenous communications and enlargement of the foveal avascular zone [2,6,7]. In our case, the tributaries of the anomalous vessel arched around the fovea, and a small branch of the temporal tributary touched the fovea.…”

Section: Discussionmentioning

confidence: 56%

Congenital retinal macrovessel: atypical presentation using optical coherence tomography

et al. 2010

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To describe a congenital retinal macrovessel with macular thickening. This case was investigated using fundus photography, fluorescein angiography, Spectralis optical coherence tomography and a 10-2 visual field test. A 23-year-old man was referred to our clinic with decreased vision in the right eye. Fundus examination of the right eye revealed a congenital retinal macrovessel that originated inferior to the superotemporal branch of the central retinal vein. Using fluorescein angiography, early filling and delayed emptying of the aberrant vein were observed. Spectralis optical coherence tomography demonstrated macular thickening and was supported by a 10-2 visual field test that revealed a relative scotoma corresponding to the same location. At the 18-month follow-up, visual acuity remained stable. Although rare, this case demonstrated that macular thickening can cause decreased visual acuity in the presence of a congenital retinal macrovessel.

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“…7 Congenital abnormalities of the retinal vasculature such as familial retinal arteriolar tortuosity have also been implicated. 8 This is the first reported case occurring in association with riding a motorcycle. The mechanism in this case was considerable straining while the subject was trying to lift the machine on its back wheel while in motion.…”

Section: Commentmentioning

confidence: 85%

Valsalva retinopathy associated with riding a motorcycle

Ioannidis

Tranos

Harris

2004

Eye

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The patient relapsed 3 months later with headache and a transient ischaemic attack while on prednisolone 30 mg/day. Labyrinthine failure had developed. Prednisolone was increased to 1 mg/kg/day and methotrexate was introduced at 15 mg/week. Within 3 months, she had developed left anterior optic neuritis with retinochoroidal oedema causing reduced visual acuity (6/24) and colour vision (15/17 Ishihara). On MRI brain scan, there was progression of ischaemic changes. Topical steroid was given and methotrexate was increased and continued at 20 mg/week. Acuity and colour vision improved to normal. Prednisolone was tapered slowly to 10-15 mg/day. Neither the keratitis nor the uveitis has recurred to date. The patient has been stable for 2 years. CommentCS presents almost equally to ophthalmology and ENT and median time to second organ involvement is 1 month. 5 At least one serious outcome (blindness, deafness, vasculitis, aortic insufficiency, or death) occurs in 63% of cases. 2 In all, 10% of patients have neurologic involvement; 2,5 although widespread CNS ischaemia has been reported in only two individuals. 5 About 30% of CS is atypical and more likely to be associated with systemic features and a poorer prognosis. 3,4 Our patient had an atypical ophthalmic mode of presentation, which probably represented acute on chronic angle closure glaucoma. Furthermore, and in keeping with her atypical CS, she had severe, widespread neurologic involvement with CNS ischaemia, optic neuritis, and peripheral neuropathy.The most common serious complication of CS is deafness, which may be ameliorated if oral steroids are started within 2 weeks of onset. 3 Ocular inflammation frequently responds to topical steroids. Systemic vasculitis usually responds to oral steroids, although aortitis may require aortic valve replacement.The role of other immunosuppressants is not established and, owing to the rarity of CS, may depend upon the collected experience of case reports. Three patients with diagnosed CS, who underwent methotrexate therapy experienced stabilised hearing and were able to reduce or discontinue steroids. 6 Our experience supports the use of methotrexate in steroidresistant patients, especially those with CNS involvement.We recommend that all patients with CS, especially atypical cases, should have regular ENT and ophthalmic assessments and that neurologic symptoms require urgent assessment. Such collaboration will help ensure appropriate and timely therapy.

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Valsalva Retinopathy Associated With a Congenital Retinal Macrovessel

Cited by 15 publications

References 4 publications

Choroidal macrovessel

Choroidal macrovessel

Congenital retinal macrovessel: atypical presentation using optical coherence tomography

Valsalva retinopathy associated with riding a motorcycle

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