Introduction: Valsalva retinopathy can cause submacular hemorrhage (SMH), which may lead to visual disturbances. SMH can extend into the subinternal limiting membrane (ILM) and vitreous spaces, sometimes occurring concomitantly with full-thickness macular holes (FTMHs). Herein, we describe a case in which sub-ILM hemorrhage was removed without peeling the ILM of the central fovea, thus preserving the foveal ILM. Case Presentation: A 48-year-old female patient developed rapid-onset bilateral visual impairment due to SMH secondary to Valsalva retinopathy. The SMH predominantly consisted of sub-ILM hemorrhage. However, detailed observation was challenging due to the dense sub-ILM hemorrhage in the left eye. Initial best-corrected visual acuity (BCVA) in the right and left eyes were 1.2 and 0.03, respectively. Intravitreal tissue plasminogen activator (tPA) and sulfur hexafluoride (SF6) gas injections were initially administered to displace the SMH in the left eye; however, the SMH could not be successfully displaced. A vitrectomy was then performed. Intraoperatively, an ILM fissure beyond the foveal region was created using ILM forceps. The balanced salt solution was sprayed onto the ILM, and the sub-ILM hemorrhage was drained into the vitreous cavity from the ILM fissure. The surgery successfully displaced the sub-ILM hemorrhage while preserving the foveal ILM. No postoperative complications were observed. Visual acuity remained at 1.2 in the right eye and improved to 1.2 in the left eye 6 months postoperatively. Conclusion: Removing foveal sub-ILM hemorrhage without peeling the foveal ILM can be a viable treatment option to preserve the foveal ILM.

Valsalva retinopathy is a preretinal hemorrhage caused by a sudden increase in intrathoracic or intra-abdominal pressure, which generally happens after sudden and intense physical effort. This case report describes a case of Valsalva preretinal hemorrhage first treated with laser membranotomy, which subsequently recurred and was retreated with a pars plana vitrectomy. An 18-year-old male was admitted due to complaints of decreased visual acuity in his right eye for three days. He had been practicing strength training in the gymnasium before the complaints started but denied trauma or other precipitating factors. Fundoscopy revealed a central preretinal hemorrhage, and he underwent laser membranotomy, which successfully released the blood from the sub-hyaloid space into the vitreous cavity. However, the following night, he went to a nightclub party and then returned with the same initial symptoms of decreased visual acuity in his right eye. Fundoscopy revealed a relapse of the hemorrhage, which was now too central for membranotomy. He was proposed for a pars plana vitrectomy, with an aspiration of the blood, which was found to be under the inner limiting membrane. The patient achieved complete functional recovery after two weeks, with visual acuities of 20/20 on his right eye. Valsalva retinopathy may be treated with a conservative non-interventional approach, but laser membranotomy and surgery may be beneficial in selected cases, promoting faster visual rehabilitation and avoiding potential long-term toxicity effects of the prolonged presence of preretinal blood. Compliance with the postoperative rest period is essential after a laser membranotomy is performed, and failure to do it may result in the recurrence of the hemorrhage.

Purpose: To present a case of Valsalva retinopathy occurring after yoga in a patient without a clear predisposing condition. Methods: A retrospective chart review was performed. Results: A 36-year-old woman presented with a 2-day history of a \"blob,\" hazy vision, and floaters in her left eye. She was performing a backbend during yoga but denied being in a headstand position. The visual acuity (VA) was 20/20-2 OS. Ophthalmoscopy showed a retinal hemorrhage inferior to the optic disc in the left eye, which was confirmed on imaging. One month later, ophthalmoscopy and imaging showed almost complete resolution of the hemorrhage with a VA of 20/20+2 OS. Conclusions: This case of Valsalva retinopathy did not involve a predisposing condition, headstand positioning, or breathing exercises. Therefore, when clinicians encounter young, healthy patients with Valsalva retinopathy, they should consider exposures to activities such as yoga as potential risk factors.

Valsalva retinopathy is an uncommon type of retinopathy that manifests as a rapid and painless vision decline, typically observed in young individuals without prior medical conditions. This condition arises from an elevated pressure within the veins of the eye, causing preretinal haemorrhage with a notable tendency to impact the macula. We describe here a case of valsalva-related sub-internal limiting membrane (sub-ILM) macular haemorrhage which was successfully treated with anti-vascular endothelial growth factor (anti-VEGF). A 27-year-old woman presented with a clinical presentation of a large sub-ILM macular haemorrhage resulting from a valsalva maneuver following a prolonged severe cough. The sub-ILM macular haemorrhage was completely resolved after being treated with three injections of intravitreal ranibizumab with a visual recovery of vision from counting fingers to 20/20 on three month follow-up.

Purpose: To report a case of severe Valsalva retinopathy secondary to intense coughing and vomiting as symptoms of COVID-19 and describe the presentation, diagnosis, and surgical management. Methods: The patient\'s subjective findings, examination, fundus photography, optical coherence tomography (OCT) examinations, and laboratory results were used to diagnose the patient. Results: Surgical management was required to remove a vitreous hemorrhage (VH) and a sub-internal limiting membrane (sub-ILM) hemorrhage. Another foveal hemorrhage was determined to be intraretinal with intraoperative OCT. The patient\'s visual acuity improved from hand motions to 20/20 OD at postoperative week 6. Conclusions: The related COVID-19 symptoms of severe coughing and vomiting led to the Valsalva retinopathy. The VH and sub-ILM hemorrhage were successfully removed surgically. On intraoperative OCT, a foveal hemorrhage was determined to be intraretinal; thus, the decision was made to monitor it and allow it to resolve over time.

This case presents a minimal invasive alternative for the treatment of subhyaloid hemorrhages. Young, female, 32 years old, with no regular medication and with no personal or ophthalmological history, reports a sudden and profound decrease in visual acuity after an episode of vomiting, with 2 days of evolution. After funduscopic observation and complementary diagnostic tests, subhyaloid hemorrhage was detected and laser hyaloidotomy was performed, with restoration of visual acuity after 1 week. Nd:YAG laser treatment made it possible to quickly restore the visual acuity of the patient after following diagnostic procedures, avoiding other types of treatments, such as pars plana vitrectomy. This case reports a Valsalva retinopathy with clinical presentation in the form of subhyaloid hemorrhage after an episode of self-limited vomiting, effectively treated with Nd: YAG laser.

Vitreous hemorrhage is associated with a myriad of conditions such as proliferative diabetic retinopathy, proliferative retinopathy following vascular occlusion and vasculitis, trauma, retinal breaks, and posterior vitreous detachment without retinal break. Multiple pathological mechanisms are associated with development of vitreous hemorrhage such as disruption of abnormal vessels, normal vessels, and extension of blood from an adjacent source. The diagnosis of vitreous hemorrhage requires a thorough history taking and clinical examination including investigations such as ultra-sonography, which help decide the appropriate time for intervention. The prognosis of vitreous hemorrhage depends on the underlying cause. Treatment options include observation, laser photo-coagulation, cryotherapy, intravitreal injections of anti-vascular endothelial growth factor, and surgery. Pars plana vitrectomy remains the cornerstone of management. Complications of vitreous hemorrhage include glaucoma (ghost cell glaucoma, hemosiderotic glaucoma), proliferative vitreoretinopathy, and hemosiderosis bulbi.

Valsalva retinopathy is a rare pathology presenting as a sudden and painless loss of vision affecting young subjects with no medical history. It is the result of an increase of intraocular venous pressure, leading to retrohyaloid haemorrhage. We describe here the clinical presentation of a retrohyaloid hemorrhage resulting from a valsalva mechanism following a sexual activity, in a 28-year-old patient treated by Neodymium:yttrium-aluminum-garnet (Nd:YAG) laser hyaloidotomy with a visual recovery of 20/20 on 3 weeks follow-up. Valsalva retinopathy is a rare and an easy-to-diagnose pathology that is safely handled by Nd:YAG laser hyaloidotomy for a quick visual acuity recovery.

Laser hyaloidotomy with Nd: YAG or green argon laser is a non-invasive, out-patient procedure in which the posterior hyaloid face is punctured and the opening enables the drainage of sub-hyaloid haemorrhage into the vitreous. The blood is absorbed gradually and vision is improved within days with gradual clearance of the macular area. Researchers recommend laser treatment in recent haemorrhages (<2 weeks) while for delayed cases invasive surgeries are advised. We report a case of delayed presentation of sub-hyaloid haemorrhage (>3 weeks) treated successfully with laser hyaloidotomy.

BACKGROUND: : \"Achoo\" is the sound that is correlated with sneezing. A sneeze, in rare occasions, it can cause Valsalva retinopathy. Usually, small bleeding gets absorbed with time. But if the haemorrhage stays for a longer period of time, it can lead to de-hemoglobinization of blood which can cause damage to the photoreceptors. If such a damage occurs over the macula, it can cause irreversible visual loss. Hence, prompt and meticulous treatment is indicated in such cases. One such case is described here where a lady suffered from a sudden bout of sneezing and presented to us after a month later. A large sub-internal limiting membrane (ILM) bleed was noted over the macula. Hence a vitrectomy with ILM peeling with drainage of blood was advised. She recovered 20/40 visual acuity one month following surgery.
OBJECTIVE: This video emphasizes on diagnosis of sub-ILM hemorrhage and the technique in which the sub-ILM bleed can be drained in the modern era of microincision vitreoretinal surgeries.
UNASSIGNED: A key aspect in such cases is to distinguish sub-ILM from sub-hyaloid bleed. Subtle differentiating points on imaging are described in the video. In cases of sub-ILM hemorrhage, the most important surgical step after performing a core vitrectomy is a good posterior vitreous detachment (PVD) induction. After that, ILM peeling is carried out with the help of finesse loop and ILM peeling forceps. Using proportional vacuum and aspiration alternatively from the cutter, the hemorrhage is displaced and drained. This step can prevent damage to the underlying retinal tissue. After the macula hemorrhage is completely cleared, an air-fluid exchange is done.
CONCLUSIONS: Teaching points include: 1. Diagnostic markers for sub-ILM hemorrhage; 2.The method of PVD induction in cases of Sub ILM hemorrhage; and 3.Technique of drainage of sub-ILM hemorrhage using proportional vacuum and aspiration function of the cutter.
UNASSIGNED: https://youtu.be/hBhfLDy9o-Y.