Valsalva Retinopathy as a Complication of Colonoscopy

Abstract

To the Editor: We read with interest the case report by Oboh et al describing the occurrence of Valsalva retinopathy following a routine colonoscopy. The retinal hemorrhage resolved within a month without any sequelae. The authors concluded that the visual prognosis in this type of retinopathy was favorable and no treatment was deemed necessary. We would like to make further supplements from the ophthalmologist’s perspective. The severity, visual prognosis, and treatment modalities of intraocular hemorrhage induced by the Valsalva maneuver depend very much on the thickness, size, and anatomic level of hemorrhage, which can be intravitreal, preretinal, intraretinal, or even in the sheath of the optic nerve leading to blindness. Although the vast majorities of cases are self-limiting, the hemorrhage may cause profound visual loss of up to 6 months if left untreated. In long-standing cases, epiretinal membrane, macular traction, and toxic effect of dissolving hemoglobin may happen and lead to disturbing visual morbidity. To achieve rapid improvement in vision and to avoid complications, dense premacular hemorrhage may be managed with laser therapy, intraocular gas injection, or surgical vitrectomy. Laser photodisruption with Neodymium:YAG laser and argon laser has been reported. Laser puncture at the posterior hyaloid membrane allows rapid diffusion of hemorrhage from the subhyaloid space into the vitreous gel to facilitate the blood absorption. This office procedure is safe and effective and can be completed in minutes. Valsalva retinopathy may also be provoked by other interventions such as dental surgery or even fundus fluorescein angiography that can induce pain, nausea, and vomiting. Adequate explanation of the procedure and sufficient sedation, antiemetic, and analgesic may minimize this potential ocular complication, especially in vulnerable patients with the TTTrisk factors of diabetes mellitus, hypertension, and bleeding tendency. Vincent Y. W. Lee, FRCS David T. L. Liu, MRCS Wai-Man Chan, MRCP, FRCS Dennis S. C. Lam, FRCS, FRCOphth Department of Ophthalmology & Visual Sciences Chinese University of Hong Kong Prince of Wales Hospital New Territories, Hong Kong People’s Republic of China