Current approaches to laser treatment of Valsalva retinopathy: the role of hyaloid puncture
DOI: 10.32364/2311-7729-2026-26-2-13
Current approaches to laser treatment of Valsalva retinopathy: the role of hyaloid puncture
A.Yu. Kazantseva1, M.G. Rabadanova1, E.V. Kremkova1, V.V. Novoderezhkin2, D.R. Khusainova2
1 Pirogov Russian National Research Medical University, Moscow, Russian Federation
2 Municipal Clinical Hospital named after O.M. Filatov, Moscow, Russian Federation
Valsalva retinopathy is an uncommon but potentially vision-threatening retinal disorder that may result in significant visual impairment in relatively young individuals. The differential diagnosis includes hypertensive retinopathy, acute posterior vitreous detachment, shaken baby syndrome, Terson syndrome, sickle cell disease, and ruptured retinal microaneurysm. Selection of the optimal treatment strategy depends on multiple clinical factors and requires an individualized approach. Recent publications have increasingly emphasized pars plana vitrectomy, which remains the treatment of choice in cases of vitreous opacity associated with subtotal or total vitreous hemorrhage. However, considerable experience has also been accumulated with neodymium-doped yttrium aluminum garnet (Nd:YAG) laser puncture of the posterior hyaloid membrane overlying the hemorrhage, demonstrating this technique to be effective, safe, and accessible. This clinical report describes a case of Valsalva retinopathy in a 47-year-old patient that developed following an episode of severe paroxysmal coughing. The effectiveness of early Nd:YAG laser membranohyaloidotomy performed shortly after hemorrhage onset was demonstrated. Adjunctive topical antioxidant therapy initiated in the acute stage appeared to accelerate hemorrhage resorption and contributed to improvement in visual acuity. This personalized multimodal approach may reduce the risk of adverse outcomes, including permanent vision loss, and increase the likelihood of complete restoration of visual function.
Keywords: Valsalva retinopathy, preretinal hemorrhage, vitreous hemorrhage, Nd:YAG laser, membranotomy, posterior hyaloidotomy, hyaloid puncture.
For citation: Kazantseva A.Yu., Rabadanova M.G., Kremkova E.V., Novoderezhkin V.V., Khusainova D.R. Current approaches to laser treatment of Valsalva retinopathy: the role of hyaloid puncture. Russian Journal of Clinical Ophthalmology. 2026;26(2):164–170 (in Russ.). DOI: 10.32364/2311-7729-2026-26-2-13
About the authors:
Angelina Yu. Kazantseva — C. Sc. (Med.), Assistant of the Acad. A.P. Nesterov Department of Ophthalmology of the Clinical Medicine Institute, Pirogov Russian National Research Medical University; 1 bldg. 6, Ostrovityanova str., Moscow, 117513, Russian Federation; ORCID iD 0000-0002-2542-3734
Madina G. Rabadanova — C. Sc. (Med.), Associate Professor of the Acad. A.P. Nesterov Department of Ophthalmology of the Institute of Clinical Medicine, Pirogov Russian National Research Medical University; 1 bldg. 6, Ostrovityanova str., Moscow, 117513, Russian Federation; ORCID iD 0000-0003-2847-3670
Elena V. Kremkova — Dr. Sc. (Med.), Professor, Professor of the Acad. A.P. Nesterov Department of Ophthalmology of the Institute of Clinical Medicine, Pirogov Russian National Research Medical University; 1 bldg. 6, Ostrovityanova str., Moscow, 117513, Russian Federation; ORCID iD 0009-0008-0096-5052
Vladimir V. Novoderezhkin — C. Sc. (Med.), Ophthalmologist at the Department of Eye Microsurgery, Municipal Clinical Hospital named after O.M. Filatov; 23, Veshnyakovskaya str., Moscow, 111539, Russian Federation; ORCID iD 0000-0003-3483-7688
Dilyara R. Khusainova — Ophthalmologist, Department of Eye Microsurgery, Municipal Clinical Hospital named after O.M. Filatov; 23, Veshnyakovskaya str., Moscow, 111539, Russian Federation; ORCID iD 0009-0001-3667-0992
Contact information: Angelina Yu. Kazantseva, e-mail: bronvis@mail.ru
Financial Disclosure: the authors has no a financial or property interest in any material or method mentioned.
There is no conflict of interest.
Received 17.03.2026.
Revised 09.04.2026.
Accepted 30.04.2026.
2. Ломухина Е.А. Опыт хирургического лечения пациентов с ретинопатией Вальсальвы. Современные технологии в офтальмологии. 2019;1:127–132. DOI: 10.25276/2312-4911-2019-1-127-132Lomukhina E.A. The experience of surgical treatment of patients with Valsalva retinopathy. Modern Technologies in Ophthalmology. 2019;1:127–132. DOI: 10.25276/2312-4911-2019-1-127-132
3. Bar-Sela S.M., Moisseiev J. Valsalva retinopathy associated with vigorous dancing in a discotheque. Ophthalmic Surg Lasers Imaging. 2007;38(1):69–71. DOI: 10.3928/15428877-20070101-12
4. Nganga Ngabou C.G.F., Makita C., Diatewa B. Hemorrhagic Valsalva retinopathy in a pregnant woman. Case Reports in Clinical Medicine. 2018;7(02):85–89. DOI: 10.4236/crcm.2018.72008
5. Шкворченко Д.О., Какунина С.А., Норман К.С. и др. Основные аспекты этиопатогенеза, диагностики и лечения субгиалоидных кровоизлияний. Офтальмохирургия. 2021;4:70–74. DOI: 10.25276/0235-4160-2021-4-70-74Shkvorchenko D.O., Kakunina S.A., Norman K.S. et al. The main aspects of etiopathogenesis, diagnosis and treatment of subhyaloid hemorrhages. Fyodorov Journal of Ophthalmic Surgery. 2021;4:70–74 (in Russ.). DOI: 10.25276/0235-4160-2021-4-70-74
6. Mansour A.M., Ojeimi G.K. Premacular subhyaloid hemorrhage following laser in situ keratomileusis. J Refract Surg. 2000;16(3):371–372. DOI: 10.3928/1081-597X-20000501-13
7. Moshfeghi A.A., Harrison S.A., Reinstein D.Z. et al. Valsalva-like retinopathy following hyperopic laser in situ keratomileusis. Ophthalmic Surg Lasers Imaging. 2006;37(6):486–488. DOI: 10.3928/15428877-20061101-08
8. Kwok A.K., Lai T.Y., Chan N.R. Epiretinal membrane formation with internal limiting membrane wrinkling after Nd:YAG laser membranotomy in Valsalva retinopathy. Am J Ophthalmol. 2003;136(4):763–766. DOI: 10.1016/s0002-9394(03)00442-2
9. Choi S.W., Lee S.J., Rah S.H. Valsalva retinopathy associated with fiberoptic gastroenteroscopy. Can J Ophthalmol. 2006;41(4):491–493. DOI: 10.1016/S0008-4182(06)80013-X
10. Gibran S.K., Kenawy N., Wong D., Hiscott P. Changes in the retinal inner limiting membrane associated with Valsalva retinopathy. Br J Ophthalmol. 2007;91(5):701–702. DOI: 10.1136/bjo.2006.104935
11. Eneh A., Almeida D. Valsalva hemorrhagic retinopathy during labour: a case report and literature review. Can J Ophthalmol. 2013;48(6):e145–e147. DOI: 10.1016/j.jcjo.2013.05.019
12. Tatlipinar S., Shah S.M., Nguyen Q.D. Optical coherence tomography features of sub-internal limiting membrane hemorrhage and preretinal membrane in Valsalva. Can J Ophthalmol. 2007;42(1):129–130.
13. Uchida K., Takeyama M., Zako M. Valsalva-like retinopathy spontaneously occurred after ocular massage. Case Rep Ophthalmol. 2015;6(1):88–92. DOI: 10.1159/000380877
14. Шадричев Ф.Е., Шкляров Е.Б., Рахманов В.В., Григорьева Н.Н. Ретинопатия (макулопатия) Valsalva. Офтальмологические ведомости. 2009;2(1):75–78.Shadrichev F.E., Shkliarov E.B., Rakhmanov V.V., Grigorieva N.N. Valsalva retinopathy (maculopathy). Ophthalmology Reports. 2009;2(1):75–78 (in Russ.).
15. Völcker D., Junker B., Hansen L.L. [Spontaneous macula hemorrhage. Subhyaloid/sub-inner limiting membrane (ILM)]. Die Ophthalmologie. 2012;109(7):702–706 (in German).
16. Сахнов С.Н., Карагодина П.А., Клокова О.А., Леонова А.А. Современный подход к лечению ретинопатии Valsalva. Саратовский научно-медицинский журнал. 2020;16(1):268–272.Sakhnov S.N., Karagodina P.A., Klokova O.A., Leonova A.A. Modern approach to Valsalva retinopathy treatment. Saratov Journal of Medical Scientific Research. 2020;16(1):268–272 (in Russ.).
17. Simakurthy S., Tripathy K. Valsalva Retinopathy. 2023 Aug 25. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026. PMID: 31424803.
18. Имантаева М.Б., Степанова И.С., Асылбекова А.С., Нурахунова В.А. Ретинопатия Valsalva (клинический случай). Точка зрения. Восток — Запад. 2018;(2):104–107. DOI: 10.25276/2410-1257-2018-2-104-107Imantaeva M.B., Stepanova I.S., Asylbekova A.S., Nurakhunova V.A. Valsalva Retinopathy (clinical case). Point of view. East-West. 2018;(2):103–107 (in Russ.). DOI: 10.25276/2410-1257-2018-2-104-107
19. Li N., Zhu Z., Yi G. et al. Valsalva retinopathy in twin-pregnancy: a case report and literature review. Am J Case Rep. 2018;19:5–9. DOI: 10.12659/ajcr.905738
20. Celik Dulger S., Ozdal P.C., Teke M.Y. Valsalva retinopathy: long-term results and management strategies. Eur J Ophthalmol. 2021;31(4):1953–1960. DOI: 10.1177/1120672120936175
21. Rohowetz L.J., Patel V., Sridhar J., Yannuzzi N.A. Valsalva retinopathy: clinical features and treatment outcomes. Retina. 2023;43(8):1317–1320. DOI: 10.1097/IAE.0000000000003772
22. Погодина Е.Г., Илюхин Д.А. Два клинических случая с применением методики ИАГ-лазерной гиалоидотомии. Вестник ОГУ. 2012;12(148):155–157.Pogodina Ye.G., Ilyukhin D.A. Two clinical cases with application of YAG-laser hyaloidotomy methods. Vestnik OSU. 2012;12(148):155–157 (in Russ.).
23. Аринова Г.П., Ли Л.С., Копбаева Д.Е. и др. Случай премакулярного кровоизлияния при ретиноваскулите. Медицина и экология. 2019;(1):132–135.Arinova G.P., Lee L.S., Kopbayeva D.Ye. et al. Case of premacular hemorrhage at retinovascultis. Medicine and Ecology. 2019;(1):132–135 (in Russ.).
24. Woszczek D., Górska A., Sirek S., Wyględowska-Promieńska D. A case of spontaneously resolving Valsalva retinopathy in a 29-year-old patient. Cureus. 2025;17(4):e82906. DOI: 10.7759/cureus.82906
25. Allam K., AlMutairi N., Ellakwa A.F., Abdelkader E. Nd:YAG laser therapy for non-resolving premacular subhyaloid hemorrhage in Saudi patients. Saudi J Ophthalmol. 2019;33(1):61–65. DOI: 10.1016/j.sjopt.2018.11.007
26. Bouladi M., Mghaieth F., Bouraoui R. et al. Valsalva retinopathy occurring after general anesthesia. Tunis Med. 2019;97(4):595–598. PMID: 31729711
27. Sotani Y., Imai H., Kishi M. et al. Removal of subinternal limiting membrane hemorrhage secondary to Valsalva retinopathy using a fovea-sparing internal limiting membrane fissure creation technique. Case Rep Ophthalmol Med. 2024;2024:2774155. DOI: 10.1155/2024/2774155
28. Bypareddy R., Chawla R., Azad S.V., Takkar B. Iatrogenic parafoveal macular hole following Nd-YAG posterior hyaloidotomy for premacular haemorrhage. BMJ Case Rep. 2016;2016:bcr2016217234. DOI: 10.1136/bcr-2016-217234
29. Gurung Z.L. Multiple retinal holes secondary to valsalva retinopathy. Case Rep Ophthalmol Med. 2018;2018:8950682. DOI: 10.1155/2018/8950682
30. Xie Z.G., Yu S.Q., Chen X. et al. Macular hole secondary to Valsalva retinopathy after doing push-up exercise. BMC Ophthalmol. 2014;14:98. DOI: 10.1186/1471-2415-14-98
31. Gurung R.L. A unique case of valsalva retinopathy in a conch blower. Am J Ophthalmol Case Rep. 2017;7:140–142. DOI: 10.1016/j.ajoc.2017.07.003
32. Khadka D., Bhandari S., Bajimaya S. et al. Nd:YAG laser hyaloidotomy in the management of Premacular Subhyaloid Hemorrhage. BMC Ophthalmol. 2016;16:41. DOI: 10.1186/s12886-016-0218-0
This work is licensed under a Creative Commons «Attribution» 4.0 License.
Распечатать