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May 2002

Subretinal Fluid in Optic Disc Edema

Arch Ophthalmol. 2002;120(5):673-674. doi:

I was interested to read the paper by Hoye et al1 in the September 2001 issue of the ARCHIVES. They found evidence of subretinal fluid accumulation "in at least 1 eye of 7 patients" of the 55 patients they examined using optic coherence tomography. While discussing the source of the subretinal fluid, they make the following statements:

Based on my studies on various aspects of optic disc edema in patients with raised intracranial pressure and other conditions, over 40 years, I must question the validity of their conclusion. First, there is the statement by Hoye et al1 that "Horseradish peroxidase studies also indicate that subretinal fluid might arise from cerebrospinal fluid." They ascribe their conclusion to the study by Peyman and Apple.2 Peyman and Apple, however, conducted 2 types of investigations in just 8 squirrel monkeys. First, 5 animals were injected with horseradish peroxidase intravenously to evaluate "peroxidase diffusion from optic nerve capillaries"2(p650); "no passage of tracer out of optic nerve capillaries" was found. Second, in 3 animals, they injected horseradish peroxidase into the vitreous to evaluate "peroxidase diffusion from the vitreous towards the optic nerve head" and found that "tracer diffused freely through the internal limiting membrane into intercellular spaces of the optic nerve parenchyma." This article does not mention horseradish peroxidase leaking from the cerebrospinal fluid into the optic nerve head, the region around the optic disc, or the subretinal space. In fact, Peyman and Apple evaluated the flow of fluids from the vitreous into the optic nerve and not from the cerebrospinal fluid into the optic nerve and subretinal space. So, the authors' conclusion that the findings "of others indicate that subretinal fluid comes from the region of the optic nerve" is based on a misrepresentation of the findings by Peyman and Apple, a fact that invalidates their conclusion.

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