Early treatment with Nd:YAG laser membranotomy and spectral-domain OCT evaluation for Valsalva retinopathy

Aim: The present study aimed to evaluate the outcome of Valsalva retinopathy treated with Nd:YAG laser membranotomy. Design: This study was a retrospective case series. Methods: Six eyes in six patients had Nd:YAG (neodymium-doped yttrium aluminium garnet) laser treatment to open a trapped hemorrhage overlying the macula. One to four laser membranotomies were performed. Best-corrected visual acuity, color fundus photographs, and spectral-domain optical coherence tomography (SD-OCT) scans were obtained before and after laser treatment. In some cases, fluorescein angiography was done before laser treatment. The average follow-up after laser treatment was 20.5 months. Results: All eyes had marked clearing of the hemorrhage and immediate improvement in vision following laser treatment, except for one patient with the clotting of the hemorrhage. In all the cases, OCT demonstrated two distinct membranes: a highly reflective band immediately above the premacular hemorrhage, corresponding to the internal limiting membrane, and an overlying patchy membrane with low optical reflectivity consistent with the posterior hyaloid membrane. The site of the laser puncture was visible in two patients, and the retinal side of the inner limiting membrane (ILM) became rough with several highly reflective spots attached to the retinal surface of the ILM. Conclusions: Nd:YAG laser treatment for Valsalva retinopathy is an effective, noninvasive, and safe procedure for patients, with rapid visual recovery and favorable outcomes. It should be performed as early as possible to avoid the clotting of the hemorrhage. OCT supported the clinical impression that the plane of the premacular hemorrhage in Valsalva retinopathy is probably under the ILM.