Yoga in the form of breathing exercises: a bane for some

Description

A 28-year-old man presented with painless defective vision in the left eye of 4-day duration. He gave a history of performing yoga in the form of breathing exercises prior to this. There were no other ocular/systemic problems. On examination, vision in the right eye was 6/6. Anterior segment/fundus was normal. His vision in the left eye was 2/60, not improving with pinhole. The anterior segment was normal. Fundus examination revealed a large subhyaloid haemorrhage involving the macula (figure 1). His systemic examination was normal. Blood pressure, full blood count, coagulation profile and blood sugars were normal. A diagnosis of valsalva retinopathy was made. The patient was subjected to argon green laser hyaloidotomy, with power 200 mw; spot size 50; duration 200 ms. There was rapid resolution of a premacular, subhyaloid haemorrhage with restoration of visual function (figures 2–5). Valsalva retinopathy develops when a rise in intrathoracic, abdominal pressure is transmitted to the eye that causes a sudden increase in the intraocular venous pressure, ruptures the superficial retinal capillaries.¹ A subhyaloid/preretinal haemorrhage is a collection of blood between the internal limiting membrane of the retina and the posterior hyaloid phase. It often occurs in healthy young adults as a result of heavy lifting, straining, vomiting, pregnancy and bleeding disorders. Cases following yoga have not been reported so far. Haemorrhage in the macula normally resolves over a period of 3 months.² When dislodged with the help of laser, it gets absorbed faster than when left alone.³ Possible complications of YAG laser hyaloidotomy include inadvertent damage to the macula, epiretinal membrane formation, internal limiting membrane wrinkling, macular hole formation and retinal detachment.¹

Figure 1.

Fundus picture of the left eye showing large premacular subhyaloid haemorrhage.

Figure 2.

Fundus picture showing drainage of blood into the vitreous immediately following YAG laser hyaloidotomy.

Figure 3.

Fundus picture taken 45 min after laser hyaloidotomy.

Figure 4.

Fundus picture taken 24 h after laser hyaloidotomy.

Figure 5.

Fundus picture showing complete resolution of the haemorrhage.

Learning points.

• Valsalva retinopathy is a unilateral or bilateral condition that occurs when increased intrathoracic or intra-abdominal pressure transmitted to the eye following coughing and straining. Cases following yoga therapy have not been reported frequently.

• Some patients may develop a poor visual outcome due to the presumed toxic effects of blood on the retinal pigment epithelium and/or epiretinal membrane formation.

• Nd:YAG laser hyaloidotomy is a safe and effective procedure. It achieves rapid resolution of premacular subhyaloid haemorrhage with restoration of visual function, preventing the need for vitreoretinal surgery.