The subretinal space: from surgical target to therapeutic compartment - A narrative review"

Subretinal surgery has evolved from a niche indication for choroidal neovascular membrane excision to a versatile microsurgical platform enabling gene and cell therapy delivery, submacular hemorrhage displacement, and removal of subretinal fibrosis or proliferative vitreoretinopathy membranes. Across these indications, the creation of a controlled subretinal bleb and atraumatic manipulation of the neurosensory retina are the technical cornerstones. Recent advances - including intraoperative optical coherence tomography, high-gauge instruments, and robotic assistance - have markedly improved surgical precision and safety. We summarize current subretinal surgical applications, describing the principles, techniques, and clinical evidence underlying each, as well as common complications and future directions toward standardized, image-guided, and robotic subretinal intervention.