Edema within the retina

[Kp109]

Edema throughout the body occurs because of increased capillary permeability usually in response to an inflammatory trigger or general vascular fluid overload. Is this a correct statement? Throughout the body, microvasculature is regenerable over time even if severely damaged. When inflammation is eliminated or other problems resolved, capillary permeability returns to normal and severely damaged capillaries are regenerated.
Here's the question: Are retinal capillaries different, such that when damaged they are not replaced by the body? Or...are they fully capable of being regenerated if no disease is present, just as are capillaries elsewhere in the human body?

[Kp109]

Perhaps nerves cells do not regenerate, and retina cells are most like nerve cells. But the issue here is not retinal cells that have atrophied. I know i have permanent damage to retinal tissue.The issue is stopping further retinal cell damage by stopping the continued edema.
And I have NO means to stop the edema at this point. I have been told to expect a gradual decline in my vision that is only moderated at best by a lifetime of nevanac, adopt and oral nepazane. I'm a steroid responder and anti-VEGFs do nothing.

So my choice is to accept this option...or risk even worse vision loss on the membrane peel surgery. The issue really is as I described above.

[Kp109]

Please help me to understand this. And correct where I am wrong. The retina is embryolgically derived from brain tissue, yes. The vascular elements are not actually in the retinal layers. The blood supply to the retina is via the choroid outside of the retinal layers. There is a disease called choroid neovascularization. Here NEW blood vessels grow to excess. So, it seems that the capacity for new capillaries exists.
Also, no cell in the body is permanent. Do not all cell undergo cells division, death, and replacement? Please help me.

Here is the debate. I have had chronic CME for three years. All known treatments have failed. Two doctors are willing to try membrane peel since I have an EMP. Two other doctors say no. Quoting from one doctor's report: "she likely has permanent microvascular damage in the macula and permanently increased capillary permeability." I assume this means surgery would be a bad idea.

On the other hand, some evidence exists that an EMP acts as an inflammatory trigger, creates tension or a barrier to pharmacological agents. Perhaps removal would allow the increased capillary permeability to respond to treatment and resolve.

I think the issue at hand is whether or not permanently increased capillary permeability makes sense. Or if you believe the body can heal itself when no inflammatory triggers or aggravating forces are present....., or if capillaries can be replaced,.... then removal of the membrane makes sense.

[Ray T Oyakawa, MD]

The retina is technically brain tissue. Severely damage capillary are lost and not replace.  Damage capillaries leak and usually can be treated with drops, injections, or laser.

Dr. O.

[Kp109]

Perhaps, regenerate is the wrong term. Based on you understanding, do damaged capillaries go away, remain in a leaky state forever or does the body resorb the old and build NEW capillaries to replace the damaged ones? This is assuming no disease is present.

[Ray T Oyakawa, MD]

General medical conditions such as hypertension, diabetes, inflammatory diseases can affect the vascular permeability.  Early changes can be reversed.  However, once the capillaries in an area are lost they do not regenerate.

Dr. O.