Experimental Retinal Detachment

Cantrill, Herbert L.; Pederson, Jonathan E.

doi:10.1001/archopht.1984.01040030595029

Cited by 32 publications

(3 citation statements)

References 16 publications

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“…The first is the retinal pigment epithelium (RPE) pumping fluid out of the (thus virtual) subretinal space toward the choriocapillaris [1]. Drugs that interfere with this active transport reduce retinal adhesiveness [2].…”

Section: The Normal Vitreoretinal Architecture: What Keeps the Retinacontrasting

confidence: 41%

Rhegmatogenous Retinal Detachment: A Reappraisal of Its Pathophysiology and Treatment

2013

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This article represents a synthesis of an extensive literature review and the authors' decades-long personal experience with both scleral buckling (SB) and vitrectomy for rhegmatogenous retinal detachment (RD). Presenting a coherent understanding of the pathophysiology and treatment of RD, the authors confirm numerous findings described in earlier publications but also challenge certain long-standing dogmas. The key argument made here is that it is extremely rare for the chain of events leading to an RD to start with a retinal pathology. Rather, the initial pathology is syneresis of the vitreous, which then allows gel movement (intraocular currents). At the point of vitreoretinal adhesion, dynamic traction is exerted on the retina, which may be sufficient to tear it. If the tear is operculated and the dynamic traction overcomes the forces keeping the neuroretina and retinal pigment epithelium (RPE) together, the heretofore virtual subretinal space becomes accessible through the retinal tear. The intraocular currents allow the free (nonbound) intravitreal fluid to enter the subretinal space, and once the amount of the incoming fluid overwhelms the draining capacity of the RPE, an RD ensues. Detachment of the posterior cortical vitreous (PVD) is not a necessary prerequisite to RD development; furthermore, PVD cannot be diagnosed preoperatively with adequate certainty with current technology such as biomicroscopy, ultrasonography or optical coherence tomography. The surgeon should expect no or only partial (anomalous) PVD at the time of surgical repair in over half of eyes. The treatment's primary goal must thus be weakening (pneumatic retinopexy, SB) or eliminating (vitrectomy) this dynamic traction. If vitrectomy is employed, it must be a truly complete vitreous removal. This includes a surgically induced PVD if one is not present, close shaving at the periphery, and removing the vitreous immediately behind the lens. The vitrectomy is followed by the creation of a chorioretinal scar around the tear and aided by some form of intraocular tamponade. The main function of the tamponade is not to temporarily cover the break but to significantly reduce the intraocular currents and thus prevent fluid entry through the break until the chorioretinal adhesion will have become sufficiently strong to seal the retinal edge around the tear; postoperative positioning is therefore not as important as currently assumed.

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Section: The Normal Vitreoretinal Architecture: What Keeps the Retinacontrasting

confidence: 41%

Rhegmatogenous Retinal Detachment: A Reappraisal of Its Pathophysiology and Treatment

2013

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“…The initial description of the brain´s glymphatic pathway [ 3 ] prompted several groups to suggest that the eye similarly houses a fluid-transport system specifically designed to clear the retina of metabolic waste products [ 51 , 52 ]. In fact, older studies had described fluid movements in the posterior part of the eye of multiple species, but had not related this to waste clearance [ 53 , 54 , 55 , 56 , 57 , 58 , 59 ]. The existence of an ocular glymphatic clearance system has now been demonstrated in rodents [ 11 ], underlining the general requirement of fluid transport in metabolically active neural tissues.…”

Section: Introductionmentioning

confidence: 99%

The Glymphatic System (En)during Inflammation

Mogensen

Delle

2021

IJMS

114

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The glymphatic system is a fluid-transport system that accesses all regions of the brain. It facilitates the exchange of cerebrospinal fluid and interstitial fluid and clears waste from the metabolically active brain. Astrocytic endfeet and their dense expression of the aquaporin-4 water channels promote fluid exchange between the perivascular spaces and the neuropil. Cerebrospinal and interstitial fluids are together transported back to the vascular compartment by meningeal and cervical lymphatic vessels. Multiple lines of work show that neurological diseases in general impair glymphatic fluid transport. Insofar as the glymphatic system plays a pseudo-lymphatic role in the central nervous system, it is poised to play a role in neuroinflammation. In this review, we discuss how the association of the glymphatic system with the meningeal lymphatic vessel calls for a renewal of established concepts on the CNS as an immune-privileged site. We also discuss potential approaches to target the glymphatic system to combat neuroinflammation.

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“…The presence of fluid transport in the posterior eye is by no means a recent discovery, having been noted previously in various species, but the physiological importance of this process had been undefined [ 37 , 38 , 39 , 40 , 41 , 42 , 43 ]. Indeed, early electron microscopy studies reported the tracer exchange between CSF and ISF within the optic nerve [ 39 , 44 , 45 , 46 ].…”

Section: Ocular Glymphatic Transportmentioning

confidence: 99%

The Ocular Glymphatic System—Current Understanding and Future Perspectives

Delle,

Wang,

Nedergaard

2024

IJMS

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The ocular glymphatic system subserves the bidirectional polarized fluid transport in the optic nerve, whereby cerebrospinal fluid from the brain is directed along periarterial spaces towards the eye, and fluid from the retina is directed along perivenous spaces following upon its axonal transport across the glial lamina. Fluid homeostasis and waste removal are vital for retinal function, making the ocular glymphatic fluid pathway a potential route for targeted manipulation to combat blinding ocular diseases such as age-related macular degeneration, diabetic retinopathy, and glaucoma. Several lines of work investigating the bidirectional ocular glymphatic transport with varying methodologies have developed diverging mechanistic models, which has created some confusion about how ocular glymphatic transport should be defined. In this review, we provide a comprehensive summary of the current understanding of the ocular glymphatic system, aiming to address misconceptions and foster a cohesive understanding of the topic.

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Experimental Retinal Detachment

Cited by 32 publications

References 16 publications

Rhegmatogenous Retinal Detachment: A Reappraisal of Its Pathophysiology and Treatment

Rhegmatogenous Retinal Detachment: A Reappraisal of Its Pathophysiology and Treatment

The Glymphatic System (En)during Inflammation

The Ocular Glymphatic System—Current Understanding and Future Perspectives

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