What is the pathophysiology of exudative retinal detachment?

Updated: Jul 27, 2020
  • Author: Lihteh Wu, MD; Chief Editor: Inci Irak Dersu, MD, MPH  more...
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Answer

Under normal conditions, water flows from the vitreous cavity to the choroid. The direction of flow is influenced by the relative hyperosmolarity of the choroid with respect to the vitreous and the RPE that actively pumps ions and water from the vitreous into the choroid. When there is an increase in the inflow of fluid or a decrease in the outflow of fluid from the vitreous cavity that overwhelms the normal compensatory mechanisms, fluid accumulates in the subretinal space leading to an exudative retinal detachment.

The composition of the choroidal interstitial fluid plays a fundamental role in the pathogenesis of an exudative retinal detachment. The composition of the choroidal interstitial fluid in turn is influenced by the degree of choroidal vascular permeability. Any pathological process that affects choroidal vascular permeability can potentially cause an exudative retinal detachment. Alternatively, damage to the RPE prevents the pumping action of fluid and can lead to fluid accumulation in the subretinal space. Several inflammatory, infectious, vascular, degenerative, malignant, or genetically determined pathological conditions have been recognized to cause exudative retinal detachments.

In preeclampsia, there is intense vasoconstriction of the choroidal arterioles, which leads to choroidal ischemia and RPE infarction. The outer blood-retinal barrier is broken down and causes increased vascular permeability.

Eyes with Coats disease exhibit vascular endothelial growth factor (VEGF) and VEGF receptors. Nine enucleated eyes with Coats disease were analyzed, and immunoreactivity for VEGF and vascular endothelial growth factor receptor 2 (VEGFR-2) was detected in macrophages and endothelia of abnormal vessels. [1]


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