Resorption Of Subretinal Fluid Research Articles

Systemic Associations with Residual Subretinal Fluid after Ranibizumab in Diabetic Macular Edema.

Purpose To investigate the impact of systemic diseases on the occurrence of subretinal fluid (SRF) in diabetic macular edema (DME) and prognostic factors for residual SRF following three consecutive monthly intravitreal ranibizumab. Methods Ninety-seven eyes from 68 patients with DME who completed 3 consecutive monthly injections of ranibizumab were enrolled. Systemic parameters mainly included chronic kidney disease (CKD), hypertension, HbA1c, and insulin dependence. Renal parameters for CKD were serum creatinine, estimated glomerular filtration rate (eGFR), and serum albumin. Ocular factors were baseline central macular thickness (CMT), severity of diabetic retinopathy (DR), and status of panretinal photocoagulation (PRP). Results Chronic kidney disease had significant correlation with baseline SRF (R = 0.397, p < 0.001 after partial correlation with adjustment for age and DR severity). As for CKD, lower serum albumin, but not eGFR or serum creatinine, was associated with baseline presence of SRF (p = 0.026, p = 0.08 and p = 0.53, resp., after adjustment for age and DR severity). Overall, lower eGFR and lower HbA1c values, contrary to popular belief, predicted the presence of residual SRF following intravitreal injections (p = 0.016 and p < 0.001, resp.). Conclusions Tight sugar control and poorer baseline kidney function may slow the resorption of SRF after anti-VEGF injections in patients with DME in the short term.

Half-dose Photodynamic Therapy for Chronic Central Serous Chorioretinopathy.

Purpose:To report the outcomes of half-dose photodynamic therapy (PDT) in patients with chronic central serous chorioretinopathy (CSC).Methods:A chart review of patients with chronic CSC who had received half-dose verteporfin PDT (3 mg/m2) was performed. The main outcome measures were resolution of subretinal fluid and best corrected visual acuity (BCVA).Results:Fifty-three eyes of 51 patients with mean age of 45.01 ± 8.9 years were studied. Three, 6 and 12 months after half-dose PDT, subretinal fluid was completely resolved in 51 eyes (96.2%). In 2 eyes (one patient), subretinal fluid decreased at 3 months but one year later, an increase in subretinal fluid was detected on optical coherence tomography (OCT) which completely resolved following additional PDT. Another patient with recurrence of subretinal fluid rejected further treatment. Mean baseline central subfield thickness was 385 ± 113.0 μm which was decreased to 235 ± 39.7, 247 ± 49.7, and 244 ± 49.52 μm after 3, 6 and 12 months, respectively (all P-values < 0.001). Mean BCVA was 0.33 ± 0.27 LogMAR before PDT and 0.11 ± 0.18, 0.11 ± 0.17, 0.17 ± 0.26 and 0.10 ± 0.23 LogMAR, 3, 6 and 12 months and at final visit (up to 60 months) after PDT, respectively (all P-values < 0.001). Improvement ≥2 lines in BCVA occurred in 20 eyes (37.7%). Statistically significant correlations were found between improvement in BCVA and baseline BCVA, baseline central subfield thickness and central subfield thickness after resorption of subretinal fluid (P < 0.001, P= 0.04 and P= 0.01, respectively). No complications attributed to PDT were observed.Conclusion:Half-dose PDT is effective for treatment of patients with chronic CSC.

Low-Fluence Photodynamic Therapy versus Subthreshold Micropulse Yellow Wavelength Laser in the Treatment of Chronic Central Serous Chorioretinopathy.

Purpose. To compare the efficacy and safety of subthreshold micropulse yellow wavelength laser (SMYL) and low-fluence photodynamic therapy (PDT) in the treatment of chronic central serous chorioretinopathy (CSC). Methods. Thirty-three eyes of 30 patients with chronic CSC received either PDT (18 eyes) or SMYL (15 eyes) therapy. Best corrected visual acuity (BCVA), subretinal fluid (SRF) height, and central macular thickness (CMT) were evaluated at the baseline visit and one, three, six, nine, and 12 months after the therapy. Results. After 12 months, mean BCVA improved from 67.3 ± 14.2 to 71.5 ± 21.4 ETDRS letters in SMYL group and from 60.7 ± 16.3 to 64.4 ± 24.9 ETDRS letters in PDT group (p = 0.285 and p = 0.440, resp.). Mean CMT decreased from 242.8 ± 80 μm to 156.9 ± 60 μm in the PDT group and from 287.3 ± 126 μm to 138.0 ± 40 μm in the SMYL group (p = 0.098 and p = 0.003, resp.). SRF resolved completely in 72.2% and 80.0% of the eyes in the PDT and SMYL groups, respectively. Mean SRF height decreased from 117.2 ± 58 μm to 31.3 ± 56 μm in the PDT group and from 130.0 ± 104 μm to 12.5 ± 21 μm in the SMYL group (p = 0.031 and p = 0.014, resp.). Conclusions. Subthreshold micropulse yellow wavelength laser seems to be effective in the treatment of chronic CSC without any side effect and results in the resorption of SRF without causing visible retinal scarring.

An Unusual and Spontaneous Resolution of a Total Rhegmatogenous Retinal Detachment

Spontaneous reattachment of rhegmatogenous retinal detachment is a rare event that involves the relief of vitreoretinal traction, closure of the retinal breaks, and reabsorption of subretinal fluid. Diffuse retinal pigmentary alterations within a sharply demarcated and convex margin are the most common findings within the areas corresponding to the reattached retina in all the cases described in the literature. The authors report the case of a 60-year-old man who experienced spontaneous reattachment of a total rhegmatogenous retinal detachment with gradual recovery of visual function and a completely restored retina. This is the first case reported that does not exhibit the ophthalmoscopic findings commonly described in the literature.

Circumscribed Choroidal Hemangioma.

Circumscribed choroidal hemangiomas are benign vascular hamartomas without systemic associations. Generally, they are orange-red elevated masses, which are found posterior to the equator. Lesions are usually solitary and unilateral. Overlying subretinal fluid, serous retinal detachment and cystoid macular edema are common findings. Intravenous fluorescein angiography, indocyanine green angiography, ultrasonography, optical coherence tomography and enhanced depth imaging are helpful ancillary tests for diagnosis of circumscribed choroidal hemangiomas. Asymptomatic circumscribed choroidal hemangiomas do not require treatment. For symptomatic lesions with exudative retinal detachment or cystoid macular edema, photodynamic therapy has emerged as the treatment of choice with high rates of tumor regression, subretinal fluid resorption and minimal complications. Lens-sparing external beam radiotherapy, plaque brachytherapy, proton beam therapy, stereotactic radiosurgery, transpupillary thermotherapy, laser photocoagulation and anti-VEGF injections are other treatment modalities.

Half-time photodynamic therapy for central serous chorioretinopathy.

To evaluate the efficacy and safety using fluorescein angiography (FA)-guided half-time photodynamic therapy (PDT) for the treatment of acute or chronic central serous chorioretinopathy (CSC) and to evaluate the prognostic factors for visual acuity. Sixteen eyes with CSC treated with the same protocol in a single hospital were retrospectively enrolled in the study; all eyes were treated using FA-guided half-time PDT (42 seconds). Logarithm of the minimal angle of resolution (logMAR) of the best-corrected visual acuity (BCVA) before and 3 months after PDT was measured. The time to complete subretinal fluid resorption was observed. Multiple regression analysis was used to evaluate the prognostic factors for logMAR of BCVA before and at 3 months after PDT and the change in logMAR after PDT. The mean (±SD) follow-up time after PDT was 12.1 (±9.2) months. The mean (±SD) logMAR of BCVA significantly improved from 0.28 (±0.21) before PDT to 0.21 (±0.21) at 3 months after PDT (p = 0.003). All eyes showed complete resolution of subretinal fluid and retinal pigmented epithelium detachment on optical coherence tomography within 5 weeks after PDT. No treatment-related complications were reported. The duration of symptoms before PDT was significantly correlated with the pre-PDT logMAR of BCVA (p = 0.004) and the post-PDT logMAR of BCVA (p = 0.0009) but not with the logMAR change after PDT (p = 0.25). Fluorescein angiography-guided half-time PDT was safe and effective in treating both acute and chronic CSC. Early treatment was important for preserving visual acuity.

FACTORS ASSOCIATED WITH OUTCOMES OF PNEUMATIC RETINOPEXY FOR RHEGMATOGENOUS RETINAL DETACHMENTS

To determine the factors associated with anatomical and visual outcomes, and complications when using pneumatic retinopexy in the management of rhegmatogenous retinal detachments. On a whole, 406 patients having undergone 422 primary pneumatic retinopexies for the management of rhegmatogenous retinal detachment at a tertiary care hospital, between January 2004 and December 2009, with a minimum follow-up of 3 months were included in this case series. Multivariate logistic regression was used to estimate associations of demographic and clinical factors with anatomical and visual outcomes. The single operation success rate was 60.7%, and final anatomical success was 99.5%. Male gender and the presence of complications were associated with single operation failure, whereas age over 65 years, poor preoperative visual acuity, the presence of complications were associated with poorer visual outcomes. Better preoperative visual acuity and absence of complications were associated with obtaining both a good visual outcome and anatomical success after a single intervention. The most common complications included new or missed tears (16.3%), delayed subretinal fluid reabsorption (12.1%), and epiretinal membrane (10.2%). Several factors are associated with pneumatic retinopexy outcomes for rhegmatogenous retinal detachments. These factors should be taken into consideration when identifying patients who would benefit from pneumatic retinopexy and those who are at risk of requiring additional interventions.

Mineralokortikoidrezeptorantagonisten als Therapieoption bei akuter und chronischer Chorioretinopathia centralis serosa

It is well known that central serous chorioretinopathy (CSCR) is triggered by endogenous and exogenous glucocorticoids but the exact pathomechanism is not completely understood. According to the results of previous studies overactivation of mineralocorticoid receptors may play a decisive role in the pathogenesis of CSCR. Experimental studies have shown that overactivation of mineralocorticoid receptors in endothelial cells of the choroid induces increased permeability. In a pilot study inhibition of mineralocorticoid receptors was successful in treating CSCR. This article reports about the use of spironolactone in the treatment of CSCR. In this observational case series spectral-domain optical coherence tomographv (SD-OCT) showed either reduction or complete reabsorption of subretinal fluid. In pilot studies and in this case series inhibition of mineralocorticoid receptors as a therapeutic option was effective and safe; however, the efficacy is difficult to distinguish from spontaneous recovery, especially in acute CSCR. For further assessment of this treatment controlled clinical trials are urgently required as this therapy would offer a new approach for patients with chronic CSCR and no tendency towards recovery.

Eksudativna bulozna ablacija retine u okviru eklampsije

Retinal detachment is a rare complication of hypertensive disorders in pregnancy. It affects 1% of women with severe preeclampsia and 10% of women with eclampsia. In most cases, spontaneous resolution occurs in few weeks, usually without sequels. We present a case of 39-year-old primipara with eclampsia, who developed bilateral serous retinal detachment three days before delivery. After delivery by Caesarean section and the establishment of normal values of blood pressure, spontaneous resorption of subretinal fluid occurred and visual acuity progressively returned to normal.

Acquired Retinoschisis with Giant Outer Layer Break and Retinal Detachment

To evaluate the natural history of a case of retinoschisis with giant outer layer break and retinal detachment. A 42-year-old patient with a sudden paracentral scotoma in the visual field of the right eye underwent the following examinations: best-corrected visual acuity, slit-lamp biomicroscopy, optical coherence tomography, ocular echography, and fundus photography. The eye examination revealed inferotemporal retinoschisis-detachment with a giant outer retinal layer break and absence of foveal involvement. No breaks in the internal retinal layer were noted. No treatment was advised in the right eye. During the 3-year follow-up, a progressive reabsorption of subretinal fluid was detected and visual acuity remained unchanged. Deliberate nontreatment of a case of nonprogressive retinoschisis-detachment carries less risk of serious complications or loss of vision than does either surgical or prophylactic treatment.

Oral clopidogrel for chronic central serous chorioretinopathy: A short-term preliminary study

PurposeTo report the efficacy of oral clopidogrel for treatment of chronic and recurrent central serous chorioretinopathy (CSC). MethodsThis is a retrospective uncontrolled case series. Fourteen eyes in 14 patients with the clinical and angiographic findings of chronic and recurrent CSC were enrolled. Clinical data including best-corrected visual acuity (BCVA), durations of symptoms, central retinal thickness (CRT) and macular volume measured on optical coherence tomography (OCT) were collected at baseline. Oral clopidogrel 75 mg daily was administrated at least for 2 weeks until the serous detachment resolved or no satisfactory result was obtained. OCT was performed monthly until the end of follow-up in all patients. Fluorescein angiography was repeated during the follow-up period in nine patients. ResultsThere were eight eyes with chronic CSC and six with recurrent CSC. After clopidogrel treatment for mean 8.07 weeks (range, 2–24 weeks), the BCVA improved or stabilized in 12 of 14 eyes (85.7%) at the end of follow-up. Nine eyes (64.3%) attained a complete resolution of serous detachment, and four (28.6%) had improvement in subretinal fluid reabsorption on OCT. The CRT and macular volume were significantly decreased compared with baseline (234.14 ± 62.46 μm vs. 355.64 ± 108.05 μm, and 7.145 ± 0.618 μL vs. 7.916 ± 1.056 μL, respectively, p < 0.001). Seven eyes (77.78%) showed decreased numbers of leaking point as well as decreased intensity of dye leakage on repeated fluorescein angiography and one eye (11.11%) had a complete resolution in previous dye leakage. Five eyes received additional treatments (four eyes with laser photocoagulation and one eye with photodynamic therapy) during or after the clopidogrel therapy. In the subgroup of patients without additional treatments, the difference of CRT and macular volume was still statistically significant. ConclusionClopidogrel seems to be effective in the treatment of chronic CSC in this study. Its antithrombotic and anti-inflammatory actions may improve the choroidal congestion and facilitate the reabsorption of subretinal fluid.

Bilateral choroidal neovascularization associated with optic nerve head drusen treated by antivascular endothelial growth factor therapy

ObjectiveTo report a good clinical outcome in a patient with bilateral choroidal neovascularization (CNV) associated with optic nerve head drusen (ONHD) treated with intravitreal ranibizumab injection.MethodsA 12-year-old girl was referred for loss of right eye vision detected in a routine check-up. Best-corrected visual acuity (BCVA) was hand movements in the right eye and 0.9 in the left eye. Funduscopy revealed the presence of superficial and buried bilateral ONHD, which was confirmed by ultrasonography and computed tomography, and the study was completed with perimetry. The presence of bilateral CNV, active in the right eye, was observed and subsequently confirmed using fluorescein angiography and optical coherence tomography.ResultsTreatment with two consecutive injections of intravitreal ranibizumab resulted in inactivation of the neovascular membrane with subretinal fluid reabsorption and improved right eye BCVA. After 12 months’ follow-up, this was 20/60 and stable.ConclusionAlthough there are no published studies of safety in children, antiangiogenic therapy for CNV secondary to ONHD may be useful and safe. A search of the literature produced only one previously reported case of ONHD-associated CNV treated with antivascular endothelial growth factor alone.

Intravitreal Pegaptanib in Ischemic CRVO Refractory Exudative Macular Detachment

Recent literature data reported evidence of the visual and/or anatomical benefits of all clinically available anti-VEGF drugs for the treatment of macular edema (ME) following Central Retinal Vein Occlusion (CRVO), up to 1-year followup. There are no randomized clinical trial data on anti-VEGF agents in ischemic CRVO-ME and the use of anti-VEGF agents to treat this condition. A 73-year old caucasian man, with a medical history of diabetes and systemic hypertension and an ophthalmic history of ischemic CRVO with cystoid macular edema was referred to our division on January 2011. The ophthalmic examination showed in right eye a visual acuity of 20/2000, a C2N1 cataract and an exudative macular detachment. On February 2011, a 0.5mg ranibizumab intravitreal injection (Lucentis®, Novartis, Basel, Switzerland) was carried out in the right eye. 15 and 25 days later the OCT showed no changes. On March 2011, we performed a 0.3mg pegaptanib sodium intravitreal injection (Macugen, Eyetech Pharmaceuticals, Inc. and Pfizer Inc, New York, NY) in the right eye and 15 days later the fluorescein angiography and the OCT examination showed reabsorption of subretinal fluid, complete disappearing of macular detachment and normalization of foveal profile, with a thickness of 240 μm and visual acuity of 20/400. Three months later, foveal profile and visual acuity were unchanged.In our refractory ischemic CRVO-ME patient, pegaptanib sodium showed prompt clinical response. In some cases, even if it is selective for the VEGF165 isoform only, pegaptanib sodium could represent a further possibility in such a therapeutic challenge.

Choroidal thickness following extrafoveal photodynamic treatment with verteporfin in patients with central serous chorioretinopathy

To evaluate the effect of verteporfin photodynamic treatment (PDT) on choroidal thickness in patients with central serous chorioretinopathy (CSC). Choroidal thickness was measured with enhanced depth imaging- optical coherence tomography (EDI-OCT) before and after verteporfin PDT (full-dose verteporfin, half-light dose) in 16 eyes in 16 patients with serous detachment of the fovea secondary to extrafoveal angiographic fluorescein leakage. Treatment was confined to the area of leakage, whereas choroidal thickness before and after treatment was assessed over a larger area of the fundus using OCT. Complete resolution of the serous detachment was seen in all 16 eyes within 1 month of extrafoveal PDT, while choroidal thickness in the area where PDT was applied decreased from 407 μm [mean; 95% confidence interval (CI(95) ) 356-458 μm] to 349 μm (mean; CI(95) 300-399 μm; p < 0.0001), and subfoveal choroidal thickness was reduced from 421 μm (mean; CI(95) 352-489 μm) to 346 μm (mean; CI(95) 278-414 μm; p = 0.0001). Initially, subfoveal choroidal thickness was significantly increased in the treated eye compared with the healthy fellow eye (mean 324 μm; CI(95) 273-376 μm; p = 0.0003), but after treatment, the difference was not significant. Photodynamic therapy of active CSC was followed by choroidal thickness reduction, not only locally but also at considerable distance from the treated area. Thus, the process that causes choroidal thickening in CSC appears to spread laterally within the choroid.

Fotodynamische Therapie bei „Secondary Sick RPE Syndrome” nach wiederholten intravitrealen Injektionen von VEGF-Inhibitoren bei Patienten mit feuchter altersabhängiger Makuladegeneration

After repeated injections of VEGF inhibitors for wet AMD some patients show therapy-resistant isolated subretinal fluid (here named secondary sick RPE syndrome). The efficacy of photodynamic therapy was examined in these cases. A group of in total 18 patients with wet AMD (14 eyes with occult and 4 with minimal classic CNV) showed therapy-resistant isolated subretinal fluid after repeated intravitreal injections of VEGF inhibitors (bevacizumab or ranibizumab). These eyes were treated with photodynamic therapy with verteporfin. After PDT the need for further intravitreal injections of VEGF inhibitors and visual acuity was examined. After a mean number of 7.1 injections of VEGF inhibitors (bevacizumab or ranibizumab), in 14 patients one PDT, in 4 patients two PDT were performed. Twelve of 18 patients showed complete resorption of subretinal fluid and needed no further intravitreal injections during a mean of 11.6 months (4 - 26) after PDT. Six patients needed a mean of 4.3 additional injections. Twelve of 18 patients showed stable visual acuity (± 5 letters ETDRS), 6 improved more than 5 letters while none of them showed visual loss. In patients with wet AMD and isolated subretinal fluid after repeated injections of bevacizumab or ranibizumab photodynamic therapy could be an option to reduce the number of further injections and to stabilise visual acuity.

Selective retina therapy for acute central serous chorioretinopathy

AimsTo evaluate selective retina therapy (SRT) as a treatment of acute central serous chorioretinopathy.Methods30 eyes of 30 patients with central serous chorioretinopathy of at least a 3 months' duration were...

Standard-Fluence versus Low-Fluence Photodynamic Therapy in Chronic Central Serous Chorioretinopathy: A Nonrandomized Clinical Trial

To evaluate the efficacy of low-fluence compared with standard-fluence rate photodynamic therapy (PDT) for treating chronic central serous chorioretinopathy. Prospective, multicenter, investigator-masked, nonrandomized clinical trial. Forty-two eyes (42 patients) with chronic central serous chorioretinopathy were enrolled; 19 eyes received indocyanine green angiography-guided standard-fluence PDT (50 J/cm(2)) and 23 eyes received indocyanine green angiography-guided low-fluence PDT (25 J/cm(2)). Primary outcome measures were the changes in mean logarithm of the minimal angle of resolution best-corrected visual acuity and the rate of eyes with complete subretinal fluid reabsorption. Secondary outcomes were the changes in central foveal thickness and choroidal perfusion. Mean logarithm of the minimal angle of resolution best-corrected visual acuity improved significantly at all time points (P < .01), in the standard-fluence group from 0.43 to 0.24 at 12 months and in the low-fluence-group from 0.46 to 0.16, without significant difference between the 2 groups. At 12 months, a complete subretinal fluid reabsorption was seen in 15 standard-fluence-treated and 21 low-fluence-treated eyes (79% vs 91%; P = .5). In 1 standard-fluence eye, choroidal neovascularization developed at 3 months, and this eye received further PDT; in the other eyes, at 12 months, a moderate-significant choriocapillaris nonperfusion was seen in 8 standard-fluence-treated and 0 low-fluence-treated eyes (44% vs 0%; P = .002). In most of the eyes, both standard-fluence PDT and low-fluence PDT resulted in complete subretinal fluid reabsorption with visual acuity improvement. Choroidal hypoperfusion related to PDT could be reduced by low-fluence PDT.

Early Laser Photocoagulation Treatment as an Option in Central Serous Chorioretinopathy

To investigate the effect of early photocoagulation in central serous chorioretinopathy. In a prospective study, 15 consecutive patients with central serous chorioretinopathy and single leakage points were treated with photocoagulation between 2 days and 8 weeks after onset of symptoms. The main outcome measures were best-corrected visual acuity and metamorphopsias (Amsler grid) at months 1 and 4 compared with baseline. Mean visual acuity improved by 1.53 lines 1 month after treatment. The mean squares involved in the Amsler grid were reduced by 2.07 squares. No relapse occurred during the follow-up period. Considering the characteristics of individuals affected by central serous chorioretinopathy, a fast recovery would be advantageous. This study identified early laser photocoagulation in central serous chorioretinopathy as an effective treatment regarding resorption of subretinal fluid, recovery of visual acuity, and improvement of metamorphopsia.

Low dose verteporfin (1.5mg/m2) in chronic idiopathic central serous chorioretinopathy

Abstract Purpose In chronic idiopathic central serous chorioretinopathy (ICSC), recent studies indicate that photodynamic therapy (PDT) could be effective in subretinal fluid resorption with reduced dose of verteporfin (3mg/m2) and reduced fluence PDT. However safety and cost issues remain to be addressed. This prospective randomized controlled study has been designed to evaluate the efficacy of a further reduced dose of verteporfin for PDT in chronic ICSC. Methods Patients with chronic ICSC greater than 3 months of documented duration were included. Visual acuity had to be &lt;20/40. The patients were randomly assigned to 2 treatment groups. They received either 3 mg/m2 or 1,5 mg/m2 verteporfin and reduced fluence PDT. All patients had visual acuity, ocular coherent tomography (OCT), fluorescein and indocyanine green (ICG) angiography on inclusion, follow up was based on ETDRS and OCT at 6 weeks, 3 and 6 months. Results Ten patients were included, randomized to each treatment group. Mean duration of symptoms prior to PDT was 6 months. After 6 month follow‐up, no significant difference between the 2 groups was observed: the reduction of mean foveal thickness was equivalent in both groups. In all treated eyes, visual acuity remained stable or improved. OCT showed a reduction in serous detachment in 2 eyes of 10 eyes, complete resolution was demonstrated in 8 of 10 eyes. None of the eyes required more than 1 treatment for recurrent serous detachment. Conclusion Our preliminary data suggest that PDT leads to resolution of serous detachments and visual improvement in patients with chronic ICSC even with a low dose of verteporfin. This will reduce the cost of PDT for each patient. Long term follow‐up should enable to address safety issues.

Klinische Manifestationen von Funktionsstörungen des retinalen Pigmentepithels

The retinal pigment epithelium (RPE) serves a variety of different functions and impairment of these functions can lead to a multitude of different diseases of the posterior segment of the eye. The RPE plays an important role as an ion and fluid pump for the reabsorption of subretinal fluid in retinal detachment. On the other hand, defects in this pump function and in the outer blood-retinal barrier formed by the RPE, lead to fluid retention in inflammatory diseases. Metaplasia of RPE cells to myofibroblasts can lead to proliferative vitreoretinopathy and tractive retinal detachment. Early age-related maculopathy is caused by disturbances of phagocytosis and metabolism of the RPE. Imbalance of the physiological equilibrium between vasoproliferative and vasoinhibitory factors secreted by the RPE is probably involved in the development of atrophic or neovascular forms of advanced age-related macular degeneration. Mutations in the different steps involved in regeneration of the visual pigment (visual cycle) may lead to retinal dystrophy. Finally, immunoregulatory properties of the RPE are responsible for the phenomenon of immunological privilege, which may facilitate clinical interventions such as gene therapy and RPE transplantation.