AN 18-YEAR-OLD healthy white man reported a sudden decrease in central visual acuity in his right eye after physical exertion, probably combined with a Valsalva maneuver, while repairing his car. He did not report other symptoms and was not taking systemic medications. Best-corrected visual acuity was 20/600 OD and 20/20 OS. Anterior segment examination and intraocular pressures were normal. Ophthalmoscopic examination of the right eye disclosed the presence of an anomalous retinal vein extending along the papillomacular bundle through the foveal avascular zone and temporally. A preretinal hemorrhage overlaid the fovea and partially obscured the underlying anomalous retinal vein (Figure 1). Figure 1. View LargeDownload Fundus photograph of the right eye showing a preretinal hemorrhage overlying the fovea and partially obscuring an anomalous congenital macrovessel. Fluorescein angiography of the right eye demonstrated blocked fluorescence from this preretinal hemorrhage (Figure 2). No evidence of choroidal neovascularization was observed. Figure 2. View LargeDownload Fluorescein angiography showing blocked fluorescence from the preretinal hemorrhage. On follow-up examination 5 weeks later, the visual acuity had improved to 20/20 OD. The preretinal hemorrhage had completely resorbed, allowing examination of the underlying retinal vasculature. Fluorescein angiography at this time disclosed the anomalous vein crossing over the foveal avascular zone, and the vein appeared normal on angiographic examination (Figure 3 and Figure 4). There is no evidence of an arteriovenous anastomosis or late leakage. Figure 3. View LargeDownload Fluorescein angiography showing the congenital retinal macrovessel. Figure 4. View LargeDownload Higher magnification of the macular area. The relation between the anomalous vessel and the foveal region is better shown. Comment The presence of a congenital retinal macrovessel in the macular area is a rare occurrence1,2 that is usually not associated with visual loss. It is very interesting that the visual loss occurred after heavy physical stress that was probably combined with a Valsalva maneuver. This event is uncommon3-5 in patients with no retinal alterations and, to our knowledge, has never been reported in association with a congenital macrovessel. We suppose that the presence of the congenital retinal macrovessel is coincidental with the preretinal hemorrhage. Reprints: Giuseppe de Crecchio, MD, Via F. P. Michetti 8, 80127 Napoli, Italy (e-mail: firstname.lastname@example.org). References 1. Brown GCDonoso LAMagargal LEGoldberg RESarin LK Congenital retinal macrovessel. Arch Ophthalmol. 1982;1001430- 1436Google ScholarCrossref 2. de Crecchio GMastursi BAlfieri MCPignalosa B Congenital retinal macrovessel. Ophthalmologica. 1986;193143- 145Google ScholarCrossref 3. Friberg TRBraunstein RABressler NM Sudden visual loss associated with sexual activity. Arch Ophthalmol. 1995;113738- 742Google ScholarCrossref 4. Schipper I Valsalvamanöver: nicht immer gutartig. Klin Monatsbl Augenheilkd. 1991;198457- 459Google ScholarCrossref 5. Jones WL Valsalva maneuver induced vitreous hemorrage. J Am Optom Assoc. 1995;66301- 304Google Scholar
Archives of Ophthalmology – American Medical Association
Published: Jan 1, 2000
Keywords: retinal diseases
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