The subretinal space is the potential space between the neurosensory retina (photoreceptor outer segments) and the retinal pigment epithelium (RPE). It represents the remnant of the embryonic optic vesicle lumen and normally contains only a thin film of fluid. In retinal detachment, this space fills with subretinal fluid, separating the neurosensory retina from the RPE and disrupting photoreceptor nutrition.
Subretinal fluid accumulation defines retinal detachment and is the primary target of treatment: pneumatic retinopexy, scleral buckling, or vitrectomy all aim to seal retinal breaks and allow the subretinal fluid to be reabsorbed, re-apposing the retina to the RPE. In wet age-related macular degeneration (AMD), fluid accumulates in the subretinal space from neovascular membranes, detected as subretinal fluid on OCT. Subretinal drug delivery is a growing area in gene therapy for retinal dystrophies, where viral vectors are injected directly into the subretinal space via a small gauge needle beneath the retina.
A retinal break allows liquefied vitreous to pass through the break into the subretinal space, progressively separating the neurosensory retina from the RPE as the fluid accumulates; vitrectomy with gas tamponade or scleral buckle flattens the retina and seal the break, allowing the RPE pump to reabsorb the subretinal fluid and restore visual function.
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