Abstract

*M. Yousfi, A. Elharrar, G. Daghouj, L. Elmaaloum, B. Allali and A. Elkettani

ABSTRACT

Pre-retinal macular hemorrhage can complicate several retinal pathologies, including Valsalva retinopathy. Located between the internal limiting membrane and the retinal optic fiber layer, the hematoma is a factor in retinal toxicity with macular sequelae. It requires emergency treatment based on YAG laser hyaloidotomy, with excellent results. We report the case of a 47-year-old man who consulted us for a sudden decrease in visual acuity in his right eye, with temporal hemianopia. The history-taking did not reveal any history of trauma. A complete ophthalmological examination of the left eye was normal, with visual acuity of 10/10. In the right eye, visual acuity was 1/100, with an examination of anterior segment without any particularities, but the fundus revealed a macular preretinal hemorrhage of 2 papillary diameters, with a flat retina and normal excavation. A biologic workup was ordered, revealing no abnormalities. However, a cardiological examination diagnosed severe aortic insufficiency with left ventricle repercussions and associated pulmonary arterial hypertension at 55mmHg on TTE. Ultrasound examination of the supra-aortic trunks revealed moderate atheromatous overload, predominantly on the right, with no significant stenosis. The patient was put on medical treatment, and the indication of aortic valve replacement was retained. After all this work-up, the diagnosis of Valsalva retinopathy was the most likely, given the patient's young age and the abrupt onset of reduced visual acuity. The patient underwent YAG laser treatment, with a favorable outcome and restoration of visual acuity to 10/10. Valsalva retinopathy should be suspected in the presence of retrohyaloid hemorrhage, especially in young patients. However, hematological research and optimal correction of cardiovascular risk factors are essential to reduce the morbidity and mortality of an underlying pathology. The Argon laser is an effective therapeutic means enabling rapid restoration of visual function without retinal complications.