Abstract：
BACKGROUND: Retinal artery macroaneurysms (RAMs) are focal dilations of the large retinal arteries. Most RAMs are asymptomatic, however, when hemorrhage or exudation caused by a RAM involves the macula, patients can experience marked vision loss. This article reported a rare case of a ruptured RAM due to the Valsalva maneuver in an elderly female with constipation and offered a review of the relevant literature.
METHODS: A 78-year-old woman with several risk factors presented with multi-level retinal hemorrhages following a Valsalva maneuver during constipation. Due to the poor coagulation and heavy bleeding in this case, the blood broke through the internal limiting membrane and drained \"on its own\" into the vitreous cavity. First, we observed the patient and controlled for her risk factors. After the blood was completely drained into the vitreous cavity, the root cause of the bleeding was found to be a RAM rupture. After laser photocoagulation, the patient\'s vision recovered significantly and remained stable for a long time despite the presence of an epiretinal membrane and a lamellar macular hole.
CONCLUSIONS: This is the first reported case of a RAM rupture by Valsalva maneuver during constipation. For multi-level hemorrhages caused by RAM, measures should be taken to drain out the sub-internal limiting membrane hemorrhage and simultaneously control for risk factors. After the RAM is exposed, laser photocoagulation can be performed.
METHODS: A 78-year-old woman with several risk factors presented with multi-level retinal hemorrhages following a Valsalva maneuver during constipation. Due to the poor coagulation and heavy bleeding in this case, the blood broke through the internal limiting membrane and drained \"on its own\" into the vitreous cavity. First, we observed the patient and controlled for her risk factors. After the blood was completely drained into the vitreous cavity, the root cause of the bleeding was found to be a RAM rupture. After laser photocoagulation, the patient\'s vision recovered significantly and remained stable for a long time despite the presence of an epiretinal membrane and a lamellar macular hole.
CONCLUSIONS: This is the first reported case of a RAM rupture by Valsalva maneuver during constipation. For multi-level hemorrhages caused by RAM, measures should be taken to drain out the sub-internal limiting membrane hemorrhage and simultaneously control for risk factors. After the RAM is exposed, laser photocoagulation can be performed.
摘要：
背景：视网膜动脉大动脉瘤（RAM）是视网膜大动脉的局灶性扩张。大多数RAM是无症状的,然而,当RAM引起的出血或渗出累及黄斑时，患者可能会出现明显的视力丧失。本文报道了一例罕见的因Valsalva动作引起的老年女性便秘的RAM破裂病例，并对相关文献进行了综述。
方法：一名78岁的女性患者，在便秘期间进行Valsalva动作后，出现多层次的视网膜出血。由于这种情况下凝血不良和大量出血，血液冲破内界膜，“自行”排入玻璃体腔。首先,我们观察了患者并控制了她的危险因素。血液完全排入玻璃体腔后,发现出血的根本原因是RAM破裂。激光光凝后，尽管存在视网膜前膜和板层黄斑裂孔，但患者的视力显著恢复并长期保持稳定。
结论：这是首次报道便秘期间Valsalva动作引起RAM破裂的病例。对于由RAM引起的多层次出血，应采取措施排出亚内界膜出血，同时控制危险因素。RAM暴露后，可以进行激光光凝。
方法：一名78岁的女性患者，在便秘期间进行Valsalva动作后，出现多层次的视网膜出血。由于这种情况下凝血不良和大量出血，血液冲破内界膜，“自行”排入玻璃体腔。首先,我们观察了患者并控制了她的危险因素。血液完全排入玻璃体腔后,发现出血的根本原因是RAM破裂。激光光凝后，尽管存在视网膜前膜和板层黄斑裂孔，但患者的视力显著恢复并长期保持稳定。
结论：这是首次报道便秘期间Valsalva动作引起RAM破裂的病例。对于由RAM引起的多层次出血，应采取措施排出亚内界膜出血，同时控制危险因素。RAM暴露后，可以进行激光光凝。
