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M. R. George, H. A. Shah, T. H. Tezel; Spontaneous Suprachoroidal Hemorrhage Secondary to Valsalva Maneuver: Case Report and Review of Literature. Invest. Ophthalmol. Vis. Sci. 2009;50(13):6067.
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To report a case of valsalva associated suprachoroidal hemorrhage in an eye with a previous scleral buckle and compare the clinical characteristics with previous similar reports to characterize the predisposing factors.
A search of the available published literature in the databases PubMed and Ovid Medline (1950 to 2008) was conducted with the key words "suprachoroidal", "hemorrhage" and "valsalva". Salient features of all cases found were noted and compared with the clinical findings of our observation. Any cases of suprachoroidal hemorrhage that occurred during intraocular surgery or in the immediate postoperative period were excluded.
Five cases were identified including our own case report. There were 3 males and 2 females (age: 62-77). Four cases, including ours, resulted in a limited peripheral suprachoroidal hemorrhage where as one was in the posterior pole. In all cases increase in intrathoracic pressure due to physical exertion preceded the suprachoroidal hemorrhage. Three cases were related to straining during bowel movement, one vomiting, and one sneezing. 4/5 cases had undergone a previous scleral buckle (1 to 11 years prior). Three patients had systemic hypertension. All hemorrhages resolved spontaneously over time (range 1 to 12 weeks).
Spontaneous suprachoroidal hemorrhage secondary to valsalva maneuver is a rare occurrence. Systemic hypertension and sudden increase in intrathoracic pressure seems to be the common features that predisposes stretched sclerotic choroidal vessels to rupture after scleral buckling. However, spontaneous resolution is common.
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