BACKGROUND: Valsalva retinopathy is a rare but sight-threatening condition with sudden visual loss. Twin-pregnancy is known as a confirmed risk factor for Valsalva retinopathy.

CASE REPORT: A 21-year-old twin-pregnant Chinese woman with 31 weeks of gestation complained of a sudden decrease of visual acuity in her right eye for five hours. Based on the patient’s medical history, clinical findings, laboratory testing and optical coherence tomography (OCT) imaging studies, Valsalva retinopathy was confirmed. Initially, we managed the patient with Nd: YAG (neodymium-doped yttrium aluminum garnet) laser to puncture the posterior portion of the vitreous. As the laser failed to puncture the posterior hyaloid face due to dense premacular hemorrhages, we switched to conservative treatment. We reviewed the case with the patient 12 weeks after an uneventful vaginal delivery. Her right visual acuity had spontaneously increased to 6/6 with no active medical intervention.

CONCLUSIONS: Valsalva retinopathy can be caused by twin-pregnancy. Patients with Valsalva retinopathy can be managed conservatively with careful prognosis following failed laser treatment. Ophthalmologists and obstetrician should coordinate properly and pay more attention to Valsalva retinopathic patients with twin-pregnancy.

Keywords: Hemorrhagic Disorders, Pregnancy, Twin, Valsalva Maneuver