Título

SEROUS RETINAL DETACHMENT ASSOCIATED WITH OPTIC NERVE PIT AFTER VALSALVA’S MANEUVER

Objetivo

1. To discuss the pathophysiology of the retinal detachment related to optic disc pit and to hypothesize the role of Valsalva's maneuver in its genesis; 2. To recommend patients with cavitary malformations of the optic nerve disc to avoid doing activities related to Valsalva's maneuver as a primary or secondary prevention of retinal detachment.

Relato do Caso

We present a 12 years old male complaining of central scotoma in the left eye 1 month ago. His best-corrected visual acuity (BCVA) was 20/20 in right eye (OD) and 20/100 in left eye (OS). The biomicroscopy was normal in both eyes and the IOP was 12 mmHg in both eyes. The OS had an inferotemporal optic nerve head pit, associated with retinal detachment in the posterior pole, extending from the temporal border of the optic disc to the entire posterior pole, without retinal breaks or traction. The OS was then submitted to papillomacular bundle laser photocoagulation. His follow-up showed an 20/20 OS visual acuity and progressive reduction in the central subfield macular thickness (CSFT) to 251 micrometers when he returned on 16th month after treatment. However, in the 19th month, patient returned reporting decrease in vision after playing his wind instrument, a bassoon. His OS BCVA was 20/40 and the macular OCT showed a CSFT of 932 micrometers. Acetazolamide 250mg/day was then prescribed and patient was oriented to not play wind instruments. In the following four months the central macular thickness has not reduced and the OS vision remained 20/60. Peripheral laser 360 degree, 0,3 mL C3F8 (octafluoropropane), facedown and papillomacular bundle laser reinforcement was then performed. After 4 months, the patient recovered the vision acuity of 20/30 OS and the CSFT to 304 micrometers.

Conclusão

Playing a wind instrument causes Valsalva's maneuver and there is evidence that this leads to intracranial pressure variation, which could promote sub retinal fluid accumulation. We recommend against doing activities that involve Valsalva's maneuver as prevention to retinal detachment in selected cases.