First Author: C.Putri UK
Co Author(s): K. Ramdil
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To describe a case of Valsalva retinopathy following an episode of forceful vomiting in pregnancy and to discuss its clinical presentation, pathophysiology, investigation and important aspects of its management in pregnancy.
This case was diagnosed and managed in a district general hospital in the UK
Retrospective case report
We report a case of a 32 year-old Asian woman, who was 27 weeks pregnant when she presented with a history of sudden onset, painless loss of vision in her left eye after an episode of forceful vomiting. She suffered from hyperemesis gravidarum during her pregnancy, otherwise she had no other significant medical problems. On Snellen chart, she attained 6/5 OD and “hand movement’’ OS. Fundus examination and optical coherence tomography (OCT) showed a large sub-internal limiting membrane (sub-ILM) haemorrhage involving the macula. Her blood pressure and blood results were normal. She was diagnosed with Valsalva retinopathy and she was managed conservatively with regular clinic and imaging follow up. This was not only because of the self-limiting nature of the condition, but also the close proximity of the lowermost and most dependent part of the haemorrhage to the fovea. Following a discussion with the obstetrics and ophthalmology team, the patient opted to undergo an elective caesarean section even though it was unlikely that this condition would have progressed during labour. 6 months after initial presentation, the pre-retinal haemorrhage resolved completely with residual sub-ILM cavity. Patient reported a complete resolution of visual symptoms and she attained 6/5 bilaterally on Snellen chart.
Valsalva retinopathy is usually a self-limiting condition caused by the rupture of superficial capillaries in retina following an elevation in intraocular venous pressure. Other important causes of retinal haemorrhage should be ruled out before making the diagnosis of Valsalva retinopathy. Especially in pregnancy, patient should be counselled regarding the potential risks and benefits of each treatment options for Valsalva retinopathy and delivery methods. Therefore, a multidisciplinary team approach is vital in managing Valsalva retinopathy in pregnancy.