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Changes in the retinal inner limiting membrane associated with Valsalva retinopathy
  1. S K Gibran,
  2. N Kenawy,
  3. D Wong,
  4. P Hiscott
  1. St Paul’s Eye Unit, Royal Liverpool Hospital, Liverpool, UK
  1. Correspondence to: S K Gibran St Paul’s Eye Unit, Royal Liverpool Hospital, Liverpool L7 8XP, UK; syedgibran{at}

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Valsalva retinopathy was first described in 1972 by Thomas Duane as “a particular form of retinopathy, pre-retinal and haemorrhagic in nature, secondary to a sudden increase in intrathoracic pressure.” Incompetent or no valves in the venous system of head and neck allow direct transmission of intrathoracic or intra-abdominal pressure into the head and neck. Sudden elevation of venous pressure may cause a decompensation in the retinal capillary bed, with subinternal limiting membrane haemorrhages (Hg) that rarely may break through and become subhyloid or intravitreal 1. We report the histological findings of internal limiting membrane (ILM) peel in a case of Valsalva retinopathy.

Case report

A 41-year-old Caucasian male was referred to the vitreoretinal services with a spontaneous and sudden loss of vision in left eye for 3 weeks. There was no history of trauma or violent exertion but the patient had hay fever and had frequent episodes of sneezing. On examination his vision was 6/6 and hand movements in right and left eyes, respectively. Anterior segment examination was normal. Dilated fundoscopy revealed a dense vitreous haemorrhage in the left eye and normal fundus appearance in the right eye. Ultrasound echography revealed a posterior vitreous detachment, vitreous …

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