title: Misdirected aqueous flow in rhegmatogenous retinal detachment: a pathophysiology update.
abstract: It is widely accepted that the origin of subretinal fluid in rhegmatogenous retinal detachment (RRD) is liquid vitreous and that posterior vitreous detachment (PVD) and associated retinal tears are caused by vitreoretinal traction from intra-ocular currents, contraction of collagen fibers, and gravity. These explanations, however, are incomplete. We present a new synthesis of experimental and clinical evidence, updating understanding of fundamental pathophysiological processes in RRD. Misdirected aqueous flow is shown to more convincingly explain the origin of subretinal fluid in clinical RRD, to be the most likely cause of acute PVD and retinal tear formation, and also to contribute to initial detachment of the retina at retinal tears. Misdirected aqueous flow in RRD is a pathophysiological process, rather than the "aqueous misdirection syndrome", and occurs without visible anterior chamber shallowing or acute glaucoma.
authors.affiliation: Ophthalmology Service, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Tabibian
authors.affiliation: Ophthalmology Service, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: Florence
authors.initials: F
authors.lastname: Hoogewoud
authors.affiliation: Ophthalmology Service, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Mavrakanas
authors.affiliation: Ophthalmology Service, Geneva University Hospitals, Geneva, Switzerland. Electronic address: js485squid@yahoo.com.
authors.forename: James S
authors.initials: JS
authors.lastname: Schutz
mesh_terms: D001082:Aqueous Humor / Q000502:physiology*; D006801:Humans; D012163:Retinal Detachment / Q000503:physiopathology*; D012167:Retinal Perforations / Q000503:physiopathology; D058471:Subretinal Fluid / Q000502:physiology; D014822:Vitreous Body / Q000473:pathology; D020255:Vitreous Detachment / Q000503:physiopathology
keywords: aqueous misdirection; pathophysiology; posterior vitreous detachment; retinal tear; rhegmatogenous retinal detachment; vitreoretinal traction