Clinical, biochemical, and immunoelectrophoretic study of subretinal fluid.

Subretinal fluid found in retinal detachments associated with retinal tears is derived from the vitreous, or from the choroidal vessels, or both.The relatively high concentration of protein found in subretinal fluid argues mainly in favour of the protein being derived from the choroidal vessels.Examinations of total protein concentration in subretinal fluid have been made by several workers.Smith and Douty (I960) and Heath, Beck, and Foulds (I962) found that the total protein concentration of the subretinal fluid tended to rise with an increase in the duration of the detachment.Heath & others (I962) felt that the rise in total protein concentration indicated an increasing permeability of the choroidal capillaries; they also found a marked increase in total protein in eyes which had undergone more than one operation.Weber and Wilson (i963) confirmed the protein findings and later stated (Weber and Wilson, I 966) that they thought the formation of subretinal fluid was a dynamic process.Cooper, Halbert, and Manski (i963), using immunoelectrophoresis, showed large numbers of serum proteins in the fifteen cases of subretinal fluid examined.Manuel, Royer, Richard, and Creyssel (i960), examining subretinal fluid by immunoelectrophoresis, found a "y" precipitin band.Speiser (I964) used a similar technique in examining eleven cases and found serum-like proteins when the total protein concentration was high, but with lower protein concentrations the globulins were relatively reduced, and with very low total protein concentrations only albumin could be detected.The purpose of this communication is to report the total protein concentrations and immunoelectrophoretic examinations of 28 specimens of subretinal fluid obtained from 26 patients suffering from retinal detachment.The technique of immunoelectrophoresis used in this study has enabled a more detailed examination of the subretinal fluid to be made than has hitherto been reported.It has allowed in particular a detailed examination of the y-globulin fraction of the subretinal fluid.The presence or absence of IgG, IgA, and 1gM may be detected, and thus it is possible to assess the degree of permeability of the choroidal capillaries and Bruch's membrane in retinal detachments. Method COLLECTION AT OPERATIONThe area around the proposed site of scleral puncture was carefully dried.Scleral puncture was