Subhi Yousif, Sørensen Torben L
Clinical Eye Research Division, Department of Ophthalmology, Zealand University Hospital, Roskilde, Denmark.
Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Case Rep Ophthalmol Med. 2017;2017:9650287. doi: 10.1155/2017/9650287. Epub 2017 Sep 12.
To describe a case of Valsalva-related subretinal hemorrhage as a presenting symptom of polypoidal choroidal vasculopathy (PCV). The patient refrained from treatment against our best advice, and thus this is also a rare case of the natural course of an untreated PCV.
Case report.
A 66-year-old female with a respiratory infection coughed intensely until exhaustion, after which she developed visual symptoms on the right eye. Primary care ophthalmologist examined the patient on the same day of the onset of symptoms and referred her to our tertiary medical retinal service for detailed retinal diagnosis including fluorescein and indocyanine green angiography. The right eye had a large subretinal hemorrhage and pigment epithelium detachment in the lower temporal arcade with foveal involvement. Against our best advice, the patient refused treatment. In the following 9 months, the BCVA decreased from 68 to 55 ETDRS letters, the subretinal hemorrhage almost regressed, pigment epithelium detachments persisted, and macular edema, intraretinal cysts, and subretinal fibrosis developed.
Although classic Valsalva retinopathy with preretinal hemorrhage in most cases can be managed by careful observation and no treatment, this case demonstrates that Valsalva-related subretinal hemorrhage needs different attention and approach.
描述1例以Valsalva动作相关的视网膜下出血为表现的息肉状脉络膜血管病变（PCV）病例。该患者不听从我们的最佳建议而未接受治疗，因此这也是1例未经治疗的PCV自然病程的罕见病例。
病例报告。
1例66岁女性，因呼吸道感染剧烈咳嗽直至疲惫不堪，之后右眼出现视觉症状。初级保健眼科医生在症状发作当天对患者进行了检查，并将她转诊至我们的三级医疗视网膜专科进行详细的视网膜诊断，包括荧光素和吲哚菁绿血管造影。右眼颞下象限下部有一大片视网膜下出血和色素上皮脱离，累及黄斑。尽管我们给出了最佳建议，但患者仍拒绝治疗。在接下来的9个月里，最佳矫正视力（BCVA）从68 ETDRS字母下降到55 ETDRS字母，视网膜下出血几乎消退，色素上皮脱离持续存在，并且出现了黄斑水肿、视网膜内囊肿和视网膜下纤维化。
虽然大多数情况下伴有视网膜前出血的典型Valsalva视网膜病变可通过仔细观察且无需治疗来处理，但本病例表明，Valsalva动作相关的视网膜下出血需要不同的关注和处理方法。
