Macular Matters

Macular Matters

Responsible for giving us sharp, clear vision,

the macula took the spotlight in the Opthalmologica lecture at the EURETINA 2021 Virtual.

Dr. Camiel J.F. Boon, professor of ophthalmology at Amsterdam University Medical Centre

and Leiden University, Netherlands, delivered the lecture, sharing valuable insights and new information.

“Due to its unique functional and anatomical characteristics, the macula is especially vulnerable to the accumulation of serous subretinal fluid,” opened

Dr. Boon. “Nevertheless, visual acuity can be relatively spared in several of these entities ลาวสามัคคี.

The differential diagnoses of these clinical entities are broad, but delineation is possible with thorough clinical history

and physical examination, with implications for therapy and prognosis.”

 It takes two to tango The optimal function of the photoreceptors requires efficient nutrient

cycling by the retinal pigment epithelium (RPE).

However, the key question of what keeps the macula attached has remained unanswered.

“The choroid has a higher protein concentration than the retina, leading to the osmotic movement of water,”

 Dr. Boon explained. “Nutrient and water transport are also mediated by active transport via ion channels.

 This net fluid movement keeps the macula dry and attached.” Dr. Boon added that the retina-choroid interface is highly regulated,

 and subretinal fluid results from a detachment of the photoreceptors from the RPE, leading to a visual decline.

Central serous chorioretinopathy (CSC) is essentially a choroid disorder, in which the underlying choroidal tissue degenerates far more severely than the retina.

The key etiological factor currently remains unknown. “In the differential diagnosis,

focal or multifocal areas of hyperfluorescent choroidal congestion and leakage are characteristic,” said

Dr. Boon. “In CSC, there is a disequilibrium in which increased choroidal permeability

and flow affects the barrier function of the RPE, eventually culminating in subretinal fluid accumulation.

 The treatment is photodynamic therapy.”

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