PMC6008859_01
Fundus photographs which were screened in the second care clinic. (a) Premacular hemorrhage was seen in the right eye of the patient. (b) Normal macula of the left eye. (c) After the Nd:YAG laser hyaloidotomy treatment, evacuation of blood from subhyaloid space was seen in the right eye.
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fig1
The clinic referred the patient with fundus photographs which were screened 4 days before (Figure 1) and after the Nd: YAG laser hyaloidotomy treatment. A diagnosis of Valsalva retinopathy was made based on the history and the treatment photographs of Nd:YAG laser hyaloidotomy (Figure 1).
First day of examination of the patient in our clinic. (A) A retinal pigment epithelium (RPE) alteration was seen at the margin of the inferior temporal arterial vascular arcade in the right eye (blue arrow) and resolved preretinal and subretinal hemorrhages were also seen. (B) Fundus fluorescein angiography of the same eye. (C-D) Normal macula of the left eye.
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fig2
But there was a retinal pigment epithelium (RPE) alteration at the margin of the inferior temporal arterial vascular arcade in the right eye and resolved preretinal and subretinal hemorrhages were seen in the macula (Figure 2). The patient was also screened with fundus fluorescein angiography for any other vascular pathologies (Figure 2).
First month of examination of the patient. (a) All hemorrhages were resolved but RPE alterations were still seen at the margin of the inferior temporal arterial vascular arcade in the right eye (blue arrow). (b) Normal macula of the left eye.
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fig3
At 1st month of examination all hemorrhages were resolved but RPE alterations were still at the margin of the inferior temporal arterial vascular arcade in the right eye (Figure 3).
At first month of examination full thickness retinal hole formation and ellipsoid zone damage at the superior and inferior margin of the inferior temporal arterial vascular arcade were seen on en face optical coherence tomography (OCT) angiogram of OCT angiography (red arrows).
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fig4
OCTA images revealed 2 lesions. On en face OCT angiogram of OCTA full thickness retinal hole formation and ellipsoid zone damage at the superior and inferior margin of the inferior temporal arterial vascular arcade were seen (Figure 4).
The projection of the evacuation of blood from subhyaloid space and the full thickness retinal hole formation were same (blue line). Superficial vascular plexus was damaged at that region.
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The projection of the evacuation of blood from subhyaloid space and the full thickness retinal hole formation were same (Figure 5).