Arnold-Vangsted Andreas, Boberg-Ans Lars Christian, Cehofski Lasse Jørgensen, van Dijk Elon H C, Grauslund Jakob, Hansen Michael Stormly, Kiilgaard Hans Christian, Klefter Oliver Niels, Krogh Nielsen Marie, Sevik Mehmet Orkun, Subhi Yousif
Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark.
Department of Ophthalmology, Innlandet Hospital Trust, Elverum, Norway.
Acta Ophthalmol. 2025 Mar;103(2):127-135. doi: 10.1111/aos.16793. Epub 2024 Nov 6.
A variety of daily activities can intentionally or unintentionally cause the Valsalva manoeuvre, which induces a physiological response of elevated peripheral venous pressure. Studies have speculated that it may ultimately affect the choroidal anatomy. This is particularly important from a clinical point-of-view since patients occasionally hold their breath while undergoing macular optical coherence tomography (OCT). In this study, we systematically reviewed the literature to understand the impact of the Valsalva manoeuvre on the choroid and conducted meta-analyses on the changes induced in the subfoveal choroidal thickness (SFCT) and the choroidal vascularity index (CVI). We searched 12 literature databases for studies in healthy participants undergoing Valsalva manoeuvre with choroidal OCT scans before and during the manoeuvre. Seven studies with a total of 444 eyes of 279 individuals were eligible for the review. The Valsalva manoeuvre led to a statistically significant but numerically small increase in the SFCT of 6.5 μm (95% CI: 1.6-11.4 μm; p = 0.01) and a statistically significant increase in the CVI of 1.48 (95% CI: 1.23-1.73; p = 0.0002). Thus, the Valsalva manoeuvre has a measurable impact on the choroid, and we recommend careful observation of how the patient sits and behaves behind the OCT scanner while scanning in order to allow accurate measurements of the choroid for diagnosis and monitoring.
各种日常活动可能有意或无意地引发瓦尔萨尔瓦动作，该动作会引起外周静脉压升高的生理反应。研究推测，这可能最终影响脉络膜解剖结构。从临床角度来看，这一点尤为重要，因为患者在进行黄斑光学相干断层扫描（OCT）时偶尔会屏气。在本研究中，我们系统回顾了文献，以了解瓦尔萨尔瓦动作对脉络膜的影响，并对中央凹下脉络膜厚度（SFCT）和脉络膜血管指数（CVI）的变化进行了荟萃分析。我们在12个文献数据库中搜索了有关健康参与者在进行瓦尔萨尔瓦动作前后接受脉络膜OCT扫描的研究。七项研究共纳入279名个体的444只眼，符合纳入综述的标准。瓦尔萨尔瓦动作导致SFCT有统计学意义但数值较小的增加，增加了6.5μm（95%CI：1.6 - 11.4μm；p = 0.01），CVI有统计学意义的增加，增加了1.48（95%CI：1.23 - 1.73；p = 0.0002）。因此，瓦尔萨尔瓦动作对脉络膜有可测量的影响，我们建议在扫描时仔细观察患者在OCT扫描仪后的坐姿和行为，以便准确测量脉络膜用于诊断和监测。
