When the Party Goes Wrong: A Case Report of Recurrent Valsalva Retinopathy Treated With Pars Plana Vitrectomy.

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.