Multiple retinal holes secondary to valsalva retinopathy
Valsalva retinopathy is a common condition but retinal holes secondary to Valsalva retinopathy are rarely reported. This is the first report to describe multiple retinal holes after hyaloidotomy for Valsalva retinopathy.

A 25-year-old male presented with sudden loss in vision of right eye (RE) following lifting heavy load. The presenting best corrected visual acuity (BCVA) in his RE was 20/200 and left eye (LE) was 20/20. Fundus evaluation of RE revealed well circumscribed dome shaped premacular haemorrhage about 3 disc diameters in size.

Since the patient was very apprehensive and requested aggressive treatment, YAG laser hyaloidotomy/membranotomy was done with Zeiss Visuals® YAG III machine with a single shot of 8 mJ applied over inferonasal border of the subhyaloid haemorrhage. At 2-week follow-up, the premacular haemorrhage was noticeably absorbed but he developed 2 full thickness retinal holes near the inferotemporal border of premacular haemorrhage along with empty cavity as bubble over macula.

At 4 weeks, the full thickness retinal holes increased to 5 in number. OCT revealed 5 full thickness retinal holes with intact but thickened internal limiting membrane (ILM) detached in convex dome shaped configuration over macula. Though there was significant resolution of haemorrhage, there was no improvement in his visual acuity. PPV with ILM peel with gas tamponade was done.

Intraoperatively, brilliant blue was used for staining, and the ILM was intact, but superficial sheen like dome shaped detachment suggestive of thickened ILM was present over the macular area. After PPV, though the fundus image shows persistence of empty bubble/cavity, there was resolution of a hyperreflective convex cavity in the post-PPV OCT with improvement in BCVA to 20/60. Six months after the onset, the BCVA, fundus examination results and OCT findings were stable.

The present case has been published in Case Reports in Ophthalmological Medicine, read more about the case here: https://pxmd.co/7FCN7
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