Valsalva retinopathy developing during Japanese cheerleading training ("ouendan").
OBJECTIVE
Valsalva hemorrhagic retinopathy is characterized by retinal hemorrhages that develop after a Valsalva maneuver that consists of a forcible exhalation against a closed glottis, thereby creating a sudden increase in the intrathoracic or intraabdominal pressure. We present a patient who developed retinal and vitreous hemorrhages with multiple retinal nonperfused areas after extreme physical training with shouting on a mountainous area. This exercise was part of his training as a member of a Japanese traditional cheerleading team.


METHODS
Case presentation.


RESULTS
A 19-year-old man developed an acute decrease in the vision to 0.3 in his left eye after running on hilly roads at approximately 800 m while shouting fight songs for several hours. Ophthalmoscopy showed a fresh vitreous hemorrhage that covered the entire macula and was connected to the optic disk in the left eye. The vitreous hemorrhage spontaneously resolved and an intraretinal hemorrhage and nonperfused area emerged. His visual acuity returned to 1.2.


CONCLUSIONS
Prolonged, strenuous physical exertion with shouting during training exercises can lead to Valsalva hemorrhagic retinopathy. Several other factors, such as hot weather, altitude, and dehydration, may have played an additive role in increasing the venous pressure and hypoxia in the retinal vessels, which then caused the retinopathy.
*Department of Ophthalmology, Kikkoman General Hospital, Chiba, Japan †Department of Ophthalmology, Teikyo University School of Medicine, Tokyo, Japan ‡Department of Ophthalmology, Teikyo University School of Medicine, University Hospital Mizonokuchi, Kawasaki, Japan §Department of Ophthalmology, Kitasato Institute Hospital, Tokyo, Japan.
Gen
G
Hanazono
Kei
K
Shinoda
Minoru
M
Obazawa
Yutaka
Y
Imamura
Soiti C
SC
Matsumoto
Shingo
S
Satofuka
Atsushi
A
Mizota
Yasutaka
Y
Ando