Cryotherapy Technique in Scleral Buckling Surgery

Technical Execution

Cryotherapy in scleral buckling is performed transscleral using a cryoprobe applied externally to the sclera overlying the retinal breaks, creating a chorioretinal adhesion through controlled freezing that extends from the ora serrata to completely surround all tears 1
Treatment must extend anteriorly to the ora serrata if tears cannot be completely surrounded, as inadequate anterior extension is a significant risk factor for surgical failure 1
The anterior border of horseshoe tears requires particular attention, as this area is difficult to visualize and inadequate treatment here commonly leads to failure 1

All retinal breaks must be completely surrounded by cryotherapy application 1
The chorioretinal adhesion from cryotherapy is not firm or complete for up to 1 month following treatment, during which continued vitreous traction can pull tears beyond the treated area 1
This delayed adhesion formation necessitates adequate initial treatment coverage 1

Insufficient anterior extension - failing to extend treatment to the ora serrata when complete surrounding is impossible 1
Inadequate treatment of horseshoe tear anterior borders - the most common site of treatment failure 1

New break development occurs in 10-16% of patients during long-term follow-up, with pseudophakic patients at higher risk 1

Scleral buckling procedures can cause multifactorial strabismus through direct muscle trauma, myotoxicity from retrobulbar anesthesia, muscle slippage or disinsertion, superior oblique tendon entanglement, and mass effect from the buckle 2, 3
Approximately 50% of patients with post-buckling diplopia have a torsional component, usually excyclotropia 4

Cryotherapy in scleral buckling creates a controlled chorioretinal adhesion through transscleral freezing that permanently seals retinal breaks, preventing subretinal fluid progression and halting retinal detachment, with the fundamental goal of creating a firm chorioretinal adhesion in the attached retina immediately adjacent to and surrounding the retinal tear 5

Treatment by prompt creation of chorioretinal adhesion reduces the risk of retinal detachment to less than 5% in symptomatic tears 6
The American Academy of Ophthalmology guidelines indicate low to very low certainty evidence showing little or no difference between pars plana vitrectomy and scleral buckling in anatomical and visual acuity outcomes, confirming that scleral buckling with cryotherapy remains a comparable and valid surgical approach 5