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Subretinal Fluid and Retinal Detachment

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Ophthalmic Signs in Practice of Medicine

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Abstract

The neurosensory retina and the RPE are normally glued to each other by an interphotoreceptor-binding protein matrix without forming any adhesions. An active pump located at the apical aspect of the RPE microvilli keeps the potential subretinal space dry. However, several disorders, including central serous chorioretinopathy, pachychoroid spectrum disorders, diabetic macular oedema, retinal vein occlusions, neovascular membrane in the macula, hypertensive choroidopathy, posterior uveitis, and metastatic lesions in the choroid, may lead to accumulation of fluid in the subretinal space termed the exudative retinal detachment. The subretinal fluid accumulates most often due to increased hydrostatic pressure in the choroid. Central serous choroidopathy is part of a pachychoroid spectrum. The increased hydrostatic pressure in the choroid is likely due to venous overload choroidopathy. Disruptions in the ellipsoid zone ELM and hyperreflective foci, inflammatory cytokines, and high blood pressure are risk factors for subretinal fluid in diabetic macular oedema. In retinal vein occlusion, excessive fluid leakage through the Muller cells may lead to subretinal fluid.

The attachment of the neurosensory retina to the RPE may be overwhelmed by tractional forces on the neurosensory retina in proliferative diabetic retinopathy, branch retinal vein occlusion, retinopathy of prematurity, and high myopia. Traction can be relieved only by surgery with subsequent absorption of the subretinal fluid.

Tears or holes in the neurosensory retina allow ocular fluids to flow into the subretinal space and cause a rhegmatogenous retinal detachment (RRD). A fresh RRD appears as a semitransparent, undulating membrane with folds in its outer layers. Depending on the location of the retinal breaks in the upper or lower half, the retinal detachment is bullous and fast progressing or shallow and slow progressing, respectively. Locating and sealing all the breaks during surgery is vital to successfully reattach the retina.

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Authors and Affiliations

  1. Advanced Eye Centre, Chandigarh, Post Graduate Institute of Medical Education and Research, Chandigarh, India

    Amod Gupta & Arun Kapil

  2. Advanced Eye Centre, Chandigarh, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India

    Reema Bansal

  3. Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India

    Aman Sharma

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Gupta, A., Bansal, R., Sharma, A., Kapil, A. (2023). Subretinal Fluid and Retinal Detachment. In: Ophthalmic Signs in Practice of Medicine. Springer, Singapore. https://doi.org/10.1007/978-981-99-7923-3_12

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