When analyzing vitreal drug delivery, or the pharmacological effects of drugs on intraocular pressure, or when interpreting outflow facility measurements, it is generally accepted that the fluid in the vitreous humor is stagnant. It is accepted that for all practical purposes, the aqueous fluid exits the eye via anterior pathways only, and so there is negligible if any posteriorly directed flow of aqueous through the vitreous humor. This assumption is largely based on the interpretation of experimental data from key sources including Maurice (1957), Moseley (1984), Gaul and Brubaker (1986), Maurice (1987) and Araie et al. (1991). However, there is strong independent evidence suggesting there is a substantial fluid flow across the retinal pigment epithelium from key sources including Cantrill and Pederson (1984), Chihara and Nao-i, Tsuboi (1985), Dahrouj et al. (2014), Smith and Gardiner (2017) and Smith et al. (2019). The conflicting evidence creates a conundrum—how can both interpretations be true? This leads us to re-evaluate the evidence. We demonstrate that the data believed to be supporting no aqueous flow through the vitreous are in fact compatible with a significant normal aqueous flow. We identify strong and independent lines of evidence supporting fluid flow across the RPE, including our new outflow model for the eye. On balance it appears the current evidence favors the view that there is normally a significant aqueous flow across the RPE in vivo. This finding suggests that past and future analyses of outflow facility, interpretations of some drug distributions and the interpretation of some drug effects on eye tissues, may need to be revised.

在分析玻璃体药物输送或药物对眼压的药理作用时，或在解释流出设施测量值时，通常认为玻璃体液中的液体是停滞的。人们普遍认为，出于所有实际目的，房水仅通过前部通路离开眼睛，因此如果有任何向后引导的房水流过玻璃体液，则可以忽略不计。这一假设很大程度上基于对主要来源实验数据的解释，包括 Maurice (1957)、Moseley (1984)、Gaul 和 Brubaker (1986)、Maurice (1987) 和 Araie 等人。 （1991）。然而，有强有力的独立证据表明，有大量的液体流过视网膜色素上皮，其关键来源包括 Cantrill 和 Pederson (1984)、Chihara 和 Nao-i、Tsuboi (1985)、Dahrouj 等人。 (2014)、史密斯和加德纳 (2017) 以及史密斯等人。 （2019）。相互矛盾的证据造成了一个难题——两种解释怎么可能都是正确的？这导致我们重新评估证据。我们证明，被认为支持没有水流通过玻璃体的数据实际上与显着的正常水流相一致。我们确定了支持液体流过 RPE 的强有力且独立的证据，包括我们新的眼睛流出模型。总的来说，目前的证据似乎支持这样的观点，即体内通常有大量的水流穿过 RPE。这一发现表明，过去和未来对流出设施的分析、对某些药物分布的解释以及对眼组织的某些药物作用的解释可能需要修改。