Subretinal

Subretinal refers to a location or process beneath the neurosensory retina and above the retinal pigment epithelium (RPE). The subretinal space is a potential space that normally contains little or no fluid or tissue.

Subretinal pathology can involve fluid, blood, or membranes and is most commonly discussed in the context of retinal detachment, subretinal hemorrhage, and subretinal neovascular membranes. Retinal detachment occurs when a retinal break allows vitreous or fluid to accumulate under the retina, separating it from the RPE. Subretinal hemorrhage can arise from choroidal neovascularization or trauma. Subretinal membranes or fibrovascular tissue may develop in neovascular diseases such as age-related macular degeneration and can affect vision.

Diagnosis and imaging rely on a combination of clinical examination and imaging techniques. Optical coherence tomography (OCT) provides detailed cross-sectional views of subretinal fluid, membranes, and their relationship to the RPE. B-scan ultrasound is useful when the media are opaque. Fluorescein angiography and indocyanine green angiography help identify neovascularization and its source.

Management depends on the underlying cause. Retinal detachment with subretinal fluid or membranes may be treated with laser photocoagulation, scleral buckling, pneumatic retinopexy, or pars plana vitrectomy. Subretinal hemorrhage may be observed if small or treated with strategies to control bleeding and support vision. Subretinal neovascular membranes due to AMD are commonly addressed with intravitreal anti-VEGF injections; larger or fibrotic lesions may require additional surgical consideration. Prognosis varies with the cause, duration, and extent of subretinal involvement.