Posterior decompensation syndrome: macular failure versus senile macular degeneration.

: Macular cone death in adults is caused by failure of the system that carries away the retinal biologic wastes. This failure may be termed the posterior decompensation syndrome, a name intended to convey the dynamic concept of imbalance between formation and elimination of waste. Because of centripetal fluid flow in the subretinal space, a disproportionate amount of drusen-like debris accumulates upon the surface of the lamina vitrea at the posterior pole. Recognition of this concept is the key to prevention of macular failure by reducing the amount of waste generated from the peripheral retina or its transport to the macula.