Retinal tears without significant subretinal fluid can be sealed by means of light coagulation. A powerful light beam from a laser is directed at the surrounds of the tear (Figure 13.2). This produces blanching of the retina around the edges of the hole and, after some days, migration and proliferation of pigment cells occurs from the RPE into the neuroretina and the blanched area becomes pigmented. A bond is formed across the potential space and a retinal detachment is prevented. This procedure can be carried out, with the aid of a contact lens, in a few minutes.
A wider and more diffuse area of chorio-retinal bonding can be achieved by cryopexy,
which entails freezing from the outside. Cry-opexy is occasionally necessary if the retinal hole is peripheral, or when there is limited blanching of the retina from laser photocoagulation because of the presence of vitreous haemorrhage. A cold probe is placed on the sclera over the site of the tear and an ice ball is allowed to form over the tear. A similar type of reaction (as occurs after photocoagulation) develops following this treatment, but it tends to be uncomfortable for the patient and local or general anaesthesia is required.
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