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Acute macular neuroretinopathy following Valsalva manoeuvre: an insight into the pathophysiology
  1. Sagar Agarwal1,
  2. Madhurima A Nayak2,
  3. Saurabh Luthra3 and
  4. Shweta Parakh3
  1. 1 Ophthalmology, Janki Eye Clinic, Khatima, India
  2. 2 Ophthalmology, Father Muller Medical College, Mangalore, Karnataka, India
  3. 3 Drishti Eye Institute, Dehradun, India
  1. Correspondence to Dr Sagar Agarwal; sagar.agarwal01{at}


Acute macular neuroretinopathy (AMN) affects the outer retina and is most likely induced by non-inflammatory ischaemia of the retinal deep capillary plexus and choriocapillaris. A man in his early 20s developed Valsalva retinopathy following weightlifting at the gym and presented with blurring of vision in the left eye 1 month after the initial retinal haemorrhages had resolved. A diffuse, purplish, donut-shaped, perifoveal lesion was seen on funduscopy and was well defined by an optical coherence tomography angiography (OCTA) en face image in the left eye. Outer retinal changes on optical coherence tomography (OCT) and a dense co-localised scotoma on a visual field (VF) examination confirmed the diagnosis of AMN, and the patient was started on a tapering dose of oral steroids. Improvement was seen in OCT, OCTA and VF during the 6-month follow-up visit. The use of OCTA en face imaging enabled the accurate identification of the lesion in the affected layers of the retina.

  • Retina
  • Macula

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  • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: SA, MAN, SL and SP. The following authors gave final approval of the manuscript: SA.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.