Cryoindentation – External retinal detachment surgery
You are young and have a retinal detachment. Your surgeon has suggested cryoindentation, a surgical procedure that treats the detachment without entering your eye. Cryoindentation is the preferred technique for retinal detachments in patients under 45-50 years old. The tear is cauterized using a cold probe (cryode), and a silicone band releases the vitreous fibers responsible for the tear (indentation). The procedure is performed on an outpatient basis, under local or general anesthesia. No gas is injected into the eye. The silicone band remains in place permanently and is perfectly tolerated.
What is scleral cryoindentation?
Cryoindentation is an operative technique in retinal surgery, aimed at treating retinal detachments WITHOUT entering the eye in order to avoid the occurrence of a cataract (unlike vitrectomy).
A closer look at the retina and retinal detachment?
The retina is the membrane located at the back of the eye. This membrane captures the light signals entering your eye and translates the perceived images into electrical signals that will be transmitted to the brain via the optic nerve.
Retinal detachment occurs when a portion of your retina separates from the back of your eye. When the retina detaches, it is damaged and does not function properly. As a result, vision is dark in the area of your field of vision corresponding to the detached retina. If left untreated, retinal detachment can lead to permanent vision loss.
The procedure can be performed under local or general anesthesia. During scleral indentation, your ophthalmologist cauterizes the tear using a cold probe (cryode) and then closes the tear by bringing the sclera (the outer layer of the eye) closer to the detached retina.
Indications for cryo-indentation
La cryoindentation est particulièrement indiquée si :
Vous avez moins de 50 ans.
N’avez pas de cataracte.
Souffrez d’un décollement de rétine inférieur.
Attention, certains décollements de rétine ne sont pas traitables par cryoindentation. Il faut dans ce cas réaliser une vitrectomie, peu importe votre âge. Le chirurgien motivera son indication et vous expliquera son raisonnement.
Preparing before the operation
Cryoindentation is performed on an outpatient basis: you arrive and leave the same day. It is most often an emergency procedure, and you will see the anesthesiologist directly in the operating room.
There is, however, one exception: chronic retinal detachment, in which case you will have time to consult the anesthesiologist a few days before.
Do not eat, drink, or smoke for 6 hours before the procedure. For everything else, follow the instructions of the emergency team.
During cryo-denting
The cryoindentation technique is simple; the tear(s) must be cauterized and a foam or silicone strip fixed behind the extraocular muscles to press the sclera against the retina.
The procedure can be performed under local or general anesthesia, depending on the team's usual practice. With local anesthesia, the entire globe is numbed.
The operation
Disinsertion of the conjunctiva over 360°.
Isolation of the 4 extraocular muscles.
The tear was located under a microscope and then cauterized.
Passing the silicone band under the extraocular muscles.
Tightening and securing the band.
If necessary, drainage of the fluid present under the retina.
Sometimes: injection of a bubble of expanding gas intended to support the retina.
Closing the conjunctiva over the sponge – this makes it invisible and your
At the end of the procedure, an antibiotic ointment and a bandage are placed on your eye to protect it. Remove them the next day.
Recovery – After cryo-denting
You will be able to return home the same day. Here are some recommendations:
Start taking painkillers a few hours after the operation because your eye will be swollen.
Don't worry about the initial appearance of your eye; it will return to normal after 2 to 3 weeks.
Apply the prescribed eye drops and ointments strictly.
Take painkillers and anti-inflammatories; you can also apply a cold mask to your face to alleviate the discomfort.
Please attend your first scheduled post-operative check-up.
Risks and complications of cryo-indentation?
Cryoindentation is a technically demanding surgery, but one that is extremely well-mastered by experienced retinal surgeons. The risks of the procedure are as follows:
Recurrent retinal detachment – The tear is not completely sealed.
Vitreous hemorrhage – Your eye is bleeding due to the drainage of fluid present under the retina.
Ocular hypertension – The indentation sponge transiently increases ocular pressure.
Retinal incarceration – During drainage of the retinal detachment, the retina becomes trapped in the puncture site, resulting in a retinal tear.
Endophthalmitis – A serious infection of the eye.
Diplopia – Double vision – The indentation strip impairs your eye movement.
Please note that the indentation slightly increases the size of your eye, causing myopia and astigmatism. This is not a complication but a logical consequence of the indentation. Myopia increases by an average of 2 diopters.