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Volume 7 Issue 11(Suppl) J Clin Exp Ophthalmol
ISSN: 2155-9570 JCEO, an open access journal
Page 44
Ophthalmology Congress 2016
December 05-06, 2016
conferenceseries.com
December 05-06, 2016 Madrid, Spain
7th European Ophthalmology Congress
Richard Luscan, J Clin Exp Ophthalmol 2016, 7:11(Suppl)
Anatomical evidence for a dialysis phenomenon (choriodialysis) between choroid and posterior retina
Adialyzing structure consists of two compartments separated by a semipermeable membrane and animated by opposite
flows, which increases the exchange surface. A pressure gradient (a dialyzing bath depression) between both compartments
directs fluid and ion exchanges but not necessarily those of gases. Clotting is avoided by heparinization of the hemodialysis
blood compartment. According to Poiseuille's law [D=flow rate= ((Πr4)/(8n l))×(P1-P2)], the session’s efficiency depends on
the homogeneity and the importance of the blood flow which will condition the exchange surface. All rheological disorder
from hyper-viscosity or partial thrombosis will alter this efficiency by reducing flow and condition the presence of deposits
called “protein-cakes” on the dialysis membrane, compounded by depression of the bath. The aim of the study was to compare
the anatomical and functional unit choriocapillaris/posterior retina [pigmentary epithelium (PE)+outer segments of vision
cells (OSVC)] to that of a dialyzing structure. An anatomical structural comparative analysis between an artificial capillary
kidney cartridge and the couple choriocapillaris/macular posterior retina is performed. It is confronted with the drusen and
pseudo-vitelliform deposit wash-out resorption flows obtained by vortex vein occlusion (VVO) in AMD. That flow will be
characterized by the mean of cine angiography ICG and OCT exams before and after VVO procedure. The two compartments
are firstly choriocapillaris which may be equated with a dialyzing bath driven by a rather centrifugal flow; secondary the couple
PE+OSVC as the dialyzed sector is driven by a centripetal flow. The bruch membrane composed partly of protein glycans
(similar to heparin composition) is the semi-permeable membrane. The pressure gradient is consisted by the epithelial pigment
physiological one. Drusen and basal linear deposits on bruch's membrane reveals analogy with the “protein-cakes” deposit. The
drusen resorption flow observed by OCT follows centrifugal choriocapillaris blood flow direction. That was demonstrated by
cine angiography ICG comparison before and after VVO procedure, showing choriocapillaris new recruitment flow restoration
and confirming the existence of a dialyzing function. Disruption of the rheological choriocapillaris hemodynamics could
limit or alter the function of the dialyzing choriocapillaris upon posterior macular retina and be a starter in some choroidal
pathogenic diseases, especially in AMD, where the ischemia is a cofactor recognized. This is for a choriocapillaris supply
disease but the dialyzing function impairment could be realized by failure of the venous drainage proximal or distal. In those
cases venous staining will provoke consequently local hyper-pressure and create a collection of edema by pigment epithelium
pump blockage. Central Serous Chorio-Retinopathy (CSCR) seems to be a concerned disease by this pathogenesis. Anatomical
and functional resemblance to that of a dialyzing artificial capillary kidney cartridge, the choriodialysis term is suited to
describe the purifying function of the choriocapillaris upon posterior macular retina.
Biography
Born in March 23 of 1949, medical studies 1967/77, including residency in Cardiology and Artificial Kidney Unit.SFO Member since 1980, SFO Oral Presentation
2005, E Poster EVRS Member since 2006, Best scientific Poster 2006 ASRS/EVRS Meeting Cannes Retina Festival, EVRS Oral presentation Prague2008/
Sevilla2012/ and Film Porto2014. All présentations up on the Vortex Vien Occlusion VVO concept.
Richard Luscan
SFO Member, France