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Purpose@#To report a case of peripapillary subretinal hemorrhage and vitreous hemorrhage after riding a roller coaster.Case summary: A 15-year-old female visited our clinic complaining of blurred vision in her left eye after repetitive roller coaster riding. The initial best-corrected visual acuity (BCVA) was 1.0 (right eye) and 0.4 (left eye). The light reflex, relative afferent pupillary defect, and intraocular pressure were within the normal range. On fundus examination, the patient was found to have a peripapillary subretinal hemorrhage, subhyaloid hemorrhage, and vitreous hemorrhage in her left eye. The BCVA of her left eye improved to 1.0 from 0.4 without any treatment after 2 weeks. The peripapillary subretinal hemorrhage and vitreous hemorrhage were completely absorbed after 7 months. @*Conclusions@#In the case of unexplained retinal hemorrhage in healthy patients without other retinal or systemic diseases, a detailed medical history should be collected to determine the possibility of disorders related to damages from riding a roller coaster.
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PURPOSE: To evaluate the effects of bevacizumab on expression of B-cell leukemia/lymphoma (Bcl)-2 and apoptosis in retinal pigment epithelial (RPE) cells under oxidative stress conditions. METHODS: RPE cells were treated with H2O2 (0, 100, 200, 300, and 400 microM) and bevacizumab at or above the doses normally used in clinical practice (0, 0.33, 0.67, 1.33, and 2.67 mg/mL). Cell apoptosis was measured using flow cytometry with annexin V-fluorescein isothiocyanate. The expression of Bcl-2 mRNA was determined using reverse transcription polymerase chain reaction. RESULTS: Under low oxidative stress conditions (H2O2 100 microM), cell apoptosis was not significantly different at any concentration of bevacizumab, but Bcl-2 mRNA expression decreased with increasing concentration of bevacizumab (0.33, 0.67, 1.33, and 2.67 mg/mL). Under moderate oxidative stress conditions (H2O2 200 microM), Bcl-2 mRNA expression decreased with increasing concentration of bevacizumab (0.33, 0.67, 1.33, and 2.67 mg/mL), but cell apoptosis increased only at 2.67 mg/mL of bevacizumab. Under high oxidative stress (300 microM) conditions, cell apoptosis increased at high concentrations of bevacizumab (1.33 and 2.67 mg/mL), but it did not correlate with Bcl-2 expression. CONCLUSIONS: Withdrawal of vascular endothelial growth factor can lead to RPE cell apoptosis and influences the expression of anti-apoptotic genes such as Bcl-2 under oxidative stress conditions. Since oxidative stress levels of each patient are unknown, repeated injections of intravitreal bevacizumab, as in eyes with age-related macular degeneration, might influence RPE cell survival.