A Case Report of Conservative Management for a Roller-Coaster-Related Vitreous Haemorrhage

Abstract

The purpose of this report is to describe the case and management of an unexplained vitreous haemorrhage that occurred after repeated roller-coaster riding. The authors inadvertently demonstrate the value of observation over immediate surgery in certain situations and review the literature on vitreoretinal and other ocular complications after roller-coaster riding. A 26-year-old male presented 12 h after riding high-velocity roller-coasters with a left vitreous haemorrhage. A hazy view of the retina and B-scan revealed a bullous area of superior-temporal retinal lifting. A diagnosis of a presumed macula-on retinal detachment was made and the patient was listed for a pars plana vitrectomy retinal detachment repair. An abnormal clotting result, which was subsequently found out to be erroneous, ultimately delayed the procedure. During this delay the vision and retinal view improved to an extent whereby the diagnosis of a retinoschisis with an intraretinal cyst was made and surgery was avoided. The patient regained 6/6 vision, without the need to undergo surgery. Historically the management of an unexplained vitreous haemorrhage was observation with serial B-scans. The current evidence and practice for treating unexplained vitreous haemorrhage have since moved towards early surgical intervention. The authors highlight that despite the current trend, a place remains for conservative management for selected cases.

Keywords: Pars plana vitrectomy; Retinoschisis; Roller-coaster; Vitreous haemorrhage.

Fig. 1

A B-scan image of the left eye demonstrating a dense vitreous haemorrhage and b an area of superior-nasal bullous retinal lifting with a cystic appearance

Fig. 2

Colour fundus images of the left eye at a day 2 post presentation demonstrating a hazy area of retinal elevation through a vitreous haemorrhage and at b–d day 28 demonstrating a superior nasal retinoschisis with an intraretinal cyst