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Subretinal Fluid andRetinal
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Detachment
12
12.1 Developmental, Anatomical,
andPhysiological Aspects
inBrief
Subretinal uid is a collection of uid in the
potential space between the neurosensory (NS)
retina and the retinal pigment epithelium (RPE),
leading to the separation of the neurosensory
retina from the RPE cell layer. Embryologically,
the vertebrate eyes develop from the neural crest
as an evagination from the ventral aspect of the
forebrain to rst form the optic vesicle. The lens
placode, arising from the surface ectoderm,
invaginates into the distal aspect of the optic vesicle to form a double-layered optic cup with a
space between the two layers. The distal aspect of
the optic cup develops into the NS retina, and the
proximal layer of the cup forms the RPE, the only
pigmented tissue in the body to develop from the
neural crest. The eye is fully formed by integrating the surrounding mesenchyme [1]. The subretinal space is thus a creation of the embryological
development of the retina. While the NSR is a
transparent multi-layered tissue, the RPE is a
mono-layered pigmented membrane. The two
have intimate contact in the normal physiological
state, with each RPE cell in contact with ~30
photoreceptors. The retina is a transparent structure tightly packed with cellular elements and
neuronal bres, allowing unhindered light access
to the photoreceptors.
Among its diverse functions, the most critical
function of the RPE is participation in the visual
cycle. The apical villi of the RPE phagocytose
the outer segments of the photoreceptors. When
the light falls on the photoreceptors, it bleaches a
visual pigment, rhodopsin, to split into all-transretinal and opsin. It triggers a nerve impulse carried onto the brain to be perceived as vision
(phototransduction). The all-trans-retinal is converted to all-trans-retinol and is transported to the
RPE, where it isomerized to the 11-cis retinal,
stored in the RPE cells, and transported across
the subretinal space to get back into outer photoreceptor segments to form rhodopsin, and the
cycle continues. On the other hand, in the day
vision photoreceptors, the cone chromophore is
recycled in the Muller glial cells, where it is
stored and converted to all-trans-retinal and
esteried to the 11-cis-retinal and transported
back to the cones to combine with the opsin to
form the cone pigment [2].
12.2 The Flow ofAqueous Fluid
intheEye
The ciliary processes secrete aqueous humour
into the eye’s posterior chamber to meet the
micronutrient and metabolic requirements of the
various intraocular structures besides keeping the
eyeball inated at an intraocular pressure
(~15 mmHg) within a narrow range of diurnal
© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023
A. Gupta et al., Ophthalmic Signs in Practice of Medicine,
https://doi.org/10.1007/978-981-99-7923-3_12
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