[Early treatment with Nd:YAG laser for Valsalva retinopathy: results of five cases and literature review]

Abstract

Introduction: According to the literature, the treatment of retinopathy of Valsalva (VR) by laser is recommended when the macular hemorrhage has not regressed after 3 weeks.

Patients and methods: We report five cases of VR treated early (≤ 24 hours) by Nd:YAG laser membranotomy (LM). Clinical examination was performed before and after LM (D1, D7, M1, M3 and M6). Optical coherence tomography (OCT) analysis was performed to determine the precise location of the macular hemorrhage.

Results: Good visual recovery was obtained early by LM with a stable outcome at 6 months. The hemorrhage was located under the internal limiting membrane (ILM) and posterior hyaloid in two patients and only under the ILM in three patients.

Discussion: The literature review and our study confirm the good functional results for patients treated by LM for VR. Furthermore, very few side effects are reported with this type of treatment compared with the natural course of the disease, which may certainly regress spontaneously, but carries a risk of secondary preretinal fibrosis. However, to obtain optimal efficacy, the treatment should be carried out as soon as possible, in order to avoid clotting of the hematoma, preventing any subsequent evacuation by laser.

Conclusion: LM for VR is an effective, safe and inexpensive technique compared to the surgical management of these patients presenting with a persistant premacular hematoma after a period of observation.

Keywords: Hémorragie rétrohyaloïdienne; Membranotomie; Membranotomy; Nd:YAG; Nd:YAG laser; Optical coherence tomography; Retrohyaloid hemorrhage; Rétinopathie de Valsalva; Tomographie en cohérence optique; Traitement; Treatment; Valsalva retinopathy.