| Purpose: Valsalva retinopathy can present as a sudden, dramatic loss of central vision due to the premacular location of the resultant subinternal limiting membrane (ILM) hemorrhage. Neodymium;yttrium-aluminum-garnet (Nd:YAG ) laser membranotomy causes immediate drainage of the hemorrhage into the vitreous and out of the visual axis, prompting a rapid return of central visual acuity and with few complications. Now we report a long-term complication of unsealed and un-reattached internal limiting membrane (ILM) in Valsalva retinopathy after Nd:YAG laser membranotomy. Methods: A 41-year-old man presented with a massive premacular hemorrhage due to Valsalva retinopathy underwent Nd:YAG laser membranotomy. During follow-up, visual acuity, retinal alteration and optical coherence tomography (OCT) outcomes were documented. Results: One month after membranotomy, his visual acuity improved from CF/1m to 20/20 and the hemorrhage resolved completely. At 8 month follow-up, the fundus showed progressive wrinkling of ILM with the laser perforation located in the center and persistent unsealed and un-reattached ILM was observed by OCT. Conclusion: Not all patients with premacular sub-ILM hemorrhage are appropriate candidates for laser membranotomy. The key point of observation is the interface between ILM and retinal surface. The long-term complication of unsealed internal limiting membrane after Nd:YAG laser membranotomy requires attention. | 
