Full-thickness macular hole associated with Valsalva retinopathy: a case report

Full-thickness macular hole (FTMH) associated with Valsalva retinopathy has been rarely reported. In this report, we describe a case of surgically treated FTMH secondary to Valsalva retinopathy.

A 59-year-old male complained of a sudden decrease in visual acuity of the left eye after straining on the toilet for 2 weeks. Best-corrected visual acuity (BCVA) of the left eye was counting fingers at 30 cm. Dilated fundus imaging revealed multiple preretinal hemorrhages involving the fovea. Optical coherence tomography (OCT) revealed a dome-shaped elevated lesion with a hyperreflective surface and hyporeflective area underneath. After 6 weeks of observation, the preretinal hemorrhages were almost completely absorbed, and visual acuity of the left eye improved to 0.06. However, OCT revealed an FTMH. After 12 weeks, no improvement in visual acuity was observed, and the macular hole did not close spontaneously. The patient underwent vitrectomy with indocyanine green-assisted internal limiting membrane peeling and gas tamponade. One month postoperatively, closed macular hole was confirmed using OCT, and the BCVA improved to 0.4.

FTMH associated with Valsalva retinopathy is rare, and its underlying mechanism requires further investigation. Surgical intervention can achieve closure of the FTMH and lead to improvement in visual acuity.