title: Bilateral retinal hemorrhages following finger pressure against the soft palate (الترفيع) in recessive CRB1-related retinopathy.
abstract: To report two siblings with CRB1-related retinopathy who developed retinal hemorrhages following village traditional treatment of upward finger pressure against the soft palate ([Formula: see text]).
  
  
  
  A retrospective case series.
  
  
  
  Two sisters were clinically diagnosed and genetically confirmed to have recessive CRB1-related retinal dystrophy. The family did not accept the condition as non-treatable and took both sisters for a traditional village therapy, consisting of several sessions of intense upward index finger pressure by the healer against the soft palate for each child. When examined following this therapy, both sisters had bilateral pre-retinal hemorrhages which were not present before the intervention and resolved without sequelae over the next several months.
  
  
  
  The traditional village therapy may have compromised retinal venous outflow and/or provoked a Valsalva phenomenon, leading to the bilateral retinal hemorrhages. The fact that this occurred bilaterally and in both sisters supports the concept of relative vessel wall incompetence as part of CRB1-related retinopathy.
authors.affiliation: a Division of Pediatric Ophthalmology, King Khaled Eye Specialist Hospital , Riyadh , Saudi Arabia.
authors.forename: Inam N
authors.initials: IN
authors.lastname: Bifari
authors.affiliation: b Eye Institute, Cleveland Clinic Abu Dhabi , Abu Dhabi , United Arab Emirates.
authors.forename: Arif O
authors.initials: AO
authors.lastname: Khan
mesh_terms: D002675:Child, Preschool; D005136:Eye Proteins / Q000235:genetics*; D005260:Female; D006801:Humans; D008518:Medicine, East Asian Traditional; D008565:Membrane Proteins / Q000235:genetics*; D009419:Nerve Tissue Proteins / Q000235:genetics*; D010160:Palate, Soft; D011312:Pressure / Q000009:adverse effects*; D058499:Retinal Dystrophies / Q000235:genetics*; D012166:Retinal Hemorrhage / Q000175:diagnosis / Q000209:etiology*; D012189:Retrospective Studies; D035781:Siblings; D041623:Tomography, Optical Coherence; D014636:Valsalva Maneuver
chemical_list: C448939:CRB1 protein, human; D005136:Eye Proteins; D008565:Membrane Proteins; D009419:Nerve Tissue Proteins
keywords: CRB1; Valsalva; retinal dystrophy; retinal hemorrhage; retinopathy; traditional therapy