Abstract
Experimental work shows that subretinal fluid is removed both by active transport across the retinal pigment epithelium (RPE) and by passive hydrostatic and oncotic forces that work most effectively when the RPE barrier has been damaged. The retina will stay attached whether or not the RPE is intact—but retinal function requires the RPE barrier and thus active transport is the primary mechanism of subretinal fluid control. RPE fluid transport is normally limited by the retina (which resists water flow from the vitreous) but can be quite powerful when a reservoir of subretinal fluid is present.
Clinical serous detachments are unlikely to form solely as a result of small RPE defects or leaks, since the active and passive transport systems for removing subretinal fluid are both so strong. It is suggested that the primary pathology in most serous retinopathy is a diffuse metabolic or vascular abnormality of RPE fluid transport, and that RPE defects or leaks are necessary but only secondary components of the disease. Several hypotheses for removing subretinal fluid therapeutically are considered in terms of their physiology.
The subretinal space between the photoreceptors and the retinal pigment epithelium (RPE) is the remnant of the embryonic optic vesicle. In the developed eye the subretinal space is of minimal size, but no tissue junctions form across it and it can re-open under pathological conditions of retinal detachment. In a sense, the title of this paper is misleading since normally there should be no subretinal fluid to control. However, ocular mechanisms are necessary to prevent an accumulation of fluid, and to remove it under conditions of stress or disease.
Article PDF
References
Frambach DA, Weiter JJ, Adler AJ : A photogrammetric method to measure fluid movement across isolated frog retinal pigment epithelium. Invest Ophthalmol Vis Sci 1985, 47: 547–52.
Hughes BA, Miller SS, Machen TE : Effects of cyclic AMP on fluid absorption and ion transport across frog retinal pigment epithelium. J Gen Physiol 1984, 83: 875–99.
Tsuboi S : Measurement of the volume flow and hydraulic conductivity across the isolated dog retinal pigment epithelium. Invest Ophthalmol Vis Sci 1987, 28: 1776–82.
Tsuboi S : Aspects of electrolyte transport across isolated dog retinal pigment epithelium. Am J Physiol 250: (Renal Fluid Electrolyte Physiol 19) 1986, F781–84.
Marmor MF, Abdul-Rahim AS, Cohen DS : The effect of metabolic inhibitors on retinal adhesion and subretinal fluid resorption. Invest Ophthalmol Vis Sci 1980, 19: 893–903.
Frambach DA and Marmor MF : The rate and route of fluid resorption from the subretinal space of the rabbit. Invest Ophthalmol Vis Sci 1982, 22: 292–302.
Negi A and Marmor MF : The resorption of subretinal fluid after diffuse damage to the retinal pigment epithelium. Invest Ophthalmol Vis Sci 1983, 24: 1475–79.
Negi A and Marmor MF : Healing of photocoagulation lesions affects the rate of subretinal fluid resorption. Ophthalmology 1984, 91: 1678–83.
Marmor MF, Negi A, Maurice DM : Kinetics of macromolecules injected into the subretinal space. Exp Eye Res 1985, 40: 687–96.
Negi A and Marmor MF : Quantitative estimation of metabolic transport of subretinal fluid. Invest Ophthalmol Vis Sci 1986, 27: 1564–68.
Negi A and Marmor MF : Mechanisms of subretinal fluid resorption in the cat eye. Invest Ophthalmol Vis Sci 1986, 27: 1560–63.
Marmor MF and Maack T : Enhancement of retinal adhesion and subretinal fluid resorption by acetazolamide. Invest Ophthalmol Vis Sci 1982, 23: 121–4.
Tsuboi S and Pederson JE : Experimental retinal detachment. X. Effect of acetazolamide on vitreous fluorescein disappearance. Arch Ophthalmol 1985, 103: 1557–8.
Cox SN, Hay E, Bird AC : Treatment of chronic macular edema with acetazolamide. Arch Ophthalmol 1988, 106: 1190–95.
Marmor MF and Negi A : Pharmacologic modification of subretinal fluid resorption. Arch Ophthalmol 1986, 104: 1674–77.
Kawano S-I and Marmor MF : Metabolic influences on the absorption of serous subretinal fluid. Invest Ophthalmol Vis Sci 1988, 29: 1255–57.
Hughes BA, Miller SS, Machen TE : Effects of cyclic AMP on fluid absorption and ion transport across frog retinal pigment epithelium. J Gen Physiol 1984, 83: 875–99.
Yoshioka H, Katsume Y, Akune H . Experimental central serous chorioretinopathy in monkey eyes: Fluorescein angiographic findings. Ophthalmologica 1982, 185: 168–78.
Yannuzzi LA : Type A behavior and central serous chorioretinopathy. Retina 1987, 7: 111–30.
Tsuboi S and Pederson JE : Volume flow across the isolated retinal pigment epithelium of cynomolgus monkey eyes. Invest Ophthalmol Vis Sci 1988, 29: 1652–55.
Johnson F and Maurice D : A simple method of measuring aqueous humor flow with intravitreal fluoresceinated dextrans. Exp Eye Res 1984, 39: 791–805.
Fatt I and Shantinath K : Flow conductivity of retina and its role in retinal adhesion. Exp Eye Res 1971, 12: 218–26.
Lincoff H and Kreissig I : The treatment of retinal detachment without drainage of subretinal fluid (modifications of the Custodis procedure: Part IV). Trans Am Acad Ophthalmol Otol 1972, 76: 1221–33.
Negi A, Kawano S-I, Marmor MF : Effects of intraocular pressure and other factors on subretinal fluid resorption. Invest Ophthalmol Vis Sci 1987, 28: 2099–102.
Negi A and Marmor MF : Effects of subretinal and systemic osmolality on the rate of subretinal fluid resorption. Invest Ophthalmol Vis Sci 1984, 25: 616–20.
Laties AM and Rapoport S : The blood-ocular barriers under osmotic stress. Arch Ophthalmol 1976, 94: 1086–91.
Foulds WS : The vitreous in retinal detachment. Trans Ophthalmol Soc UK 1975, 95: 412–16.
Marmor MF : Mechanisms of normal retinal adhesion. In Ryan SJ, Schachat AP, Murphy RB, Patz A eds, Retina, St. Louis: CV Mosby Co 1989: 71–87.
Negi A and Marmor MF : Experimental serous retinal detachment and focal pigment epithelial damage. Arch Ophthalmol, 1984, 102: 445–49.
Foulds WS : Experience of local excision of uveal melanomas. Trans Ophthalmol Soc UK 1977, 97: 412–15.
Peyman GA and Raichand M : Full-thickness eye wall resection of choroidal neoplasms. Ophthalmology 1979, 86: 1024–36.
Marmor MF : New hypotheses on the pathogenesis and treatment of serous retinal detachment. Graefe's Arch Klin Exp Ophthalmol 1988, 226: 548–52.
Foulds WS : Do we need a retinal pigment epithelium (or choroid) for the maintenance of retinal apposition? Br J Ophthalmol 1985, 69: 237–39.
Marmor MF : Commentary on ‘Do we need a pigment retinal epithelium (or choroid) for maintenance of retinal apposition?’ by W Foulds. Surv Ophthalmol 1986, 34: 344–45.
Tsukahara Y, Kawano S-I, Marmor MF : Studies on the mechanism of serous detachment. Graefe Arch Klin Exp Ophthalmol (Submitted).
Fishman GA, Gilbert LD, Fiscella RG, Kimura AE : Acetazolamide for treatment of chronic edema in retinitis pigmentosa. Arch Ophthalmol 1989, 107: 1445–52.
Olk RJ : Modified grid argon (blue-green) laser photocoagulation for diffuse diabetic macular edema. Ophthalmology 1986, 93: 938–50.
Author information
Authors and Affiliations
Additional information
Supported in part by NIH-NEI Research Grant EYO1678.
Rights and permissions
About this article
Cite this article
Marmor, M. Control of subretinal fluid: Experimental and clinical studies. Eye 4, 340–344 (1990). https://doi.org/10.1038/eye.1990.46
Issue Date:
DOI: https://doi.org/10.1038/eye.1990.46
This article is cited by
-
Retinal detachment
Nature Reviews Disease Primers (2024)
-
Effect of external subretinal fluid drainage on persistent subretinal fluid after scleral buckle surgery in macula-involving rhegmatogenous retinal detachment
Scientific Reports (2023)
-
Is gas/air tamponade essential for eyes with small peripheral retinal breaks without detachment during vitrectomy?
BMC Ophthalmology (2022)
-
Regression patterns of central serous chorioretinopathy using en face optical coherence tomography
Graefe's Archive for Clinical and Experimental Ophthalmology (2022)
-
Choroidal thickening in retinal vein occlusion patients with serous retinal detachment
Graefe's Archive for Clinical and Experimental Ophthalmology (2021)