Mechanisms of fluid accumulation in retinal edema
Mechanisms of fluid accumulation in retinal edema
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DOI：
10.1023/a:1002192829817
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发表时间：
1999-01-01
影响因子：
1.4
通讯作者：
Marmor, MF
中科院分区：
文献类型：
--
作者：
Marmor, MF
本文综述了视网膜内液体积聚的解剖和生理条件。视网膜水肿起源于导致视网膜毛细血管和/或视网膜色素上皮（RPE）中的血-视网膜屏障破坏的疾病。水肿的发生不仅是因为蛋白质和液体进入细胞外空间，而且是因为视网膜内的外界膜和回旋的细胞外通路限制了白蛋白和其他大的抗肿瘤活性分子的清除。这些分子与水结合导致水肿。由于血管造影标记物（荧光素和ICG）的大小与白蛋白不匹配，以及临床渗漏并不总是与组织肿胀或功能丧失密切相关，因此临床上对水肿的识别较为复杂。穿过RPE的主动水运输在去除视网膜下水方面是有效的，但是视网膜的流动阻力限制了RPE接近视网膜水肿的水。考虑视网膜水肿的病理生理学可能有助于制定更好的策略来管理视网膜水肿。
This paper reviews the anatomic and physiologic conditions which predispose to fluid accumulation within the retina. Retinal edema has its inception in disease that causes a breakdown of the blood-retinal barrier in retinal capillaries and/or the retinal pigment epithelium (RPE). Edema develops not only because protein and fluid enter the extracellular space, but because the external limiting membrane and the convoluted extracellular pathway within the retina limit the clearance of albumin and other large osmotically-active molecules. These molecules bind water to cause edema. Recognition of edema clinically is complicated by the facts that angiographic markers (fluorescein and ICG) do not match albumin in size, and that clinical leakage does not always correlate closely with tissue swelling or functional loss. Active water transport across the RPE is efficient at removing subretinal water, but the flow resistance of the retina limits RPE access to the water of retinal edema. Consideration of the pathophysiology of retinal edema may aid in the development of better strategies for managing retinal edema.