Valsalva retinopathy associated with a congenital retinal macrovessel.

Abstract

AN 18- YEAR-OLD healthy white man reported a sudden decrease in central visual acuity in his right eye after physical exertion, probably combined with a Valsalva maneuver, while repairing his car. He did not report other symptoms and was not taking systemic medications. Best-corrected visual acuity was 20/600 OD and 20/20 OS. Anterior segment examination and intraocular pressures were normal. Ophthalmoscopic examination of the right eye disclosed the presence of an anomalous retinal vein extending along the papillomacular bundle through the foveal avascular zone and temporally. A preretinal hemorrhage overlaid the fovea and partially obscured the underlying a nomalous r etinal v ein (Figure 1). Fluorescein angiography of the right eye demonstrated blocked fluorescence from this preretinal hemorrhage (Figure 2). No evidence of choroidal neovascularization was observed. On follow-up examination 5 weeks later, the visual acuity had improved to 20/20 OD. The preretinal hemorrhage had completely resorbed, allowing examination of the underlying retinal vasculature. Fluorescein angiography at this time disclosed the anomalous vein crossing over the foveal avascular zone, and the vein appeared normal on angiographic examination (Figure 3 and Figure 4). There is no evidence of an arteriovenous anastomosis or late leakage.