Endolaser, cryopexy, and retinal reattachment in the air-filled eye. A clinicopathologic correlation

R. N. Johnson, A. R. Irvine and I. S. Wood

We report the histopathology of intraocular argon blue-green laser photocoagulation lesions and transscleral cryopexy lesions in the air-filled human eye. Two days after treatment, the cryopexy lesions showed full-thickness retinal involvement, including disruption of the internal limiting lamina. The laser lesions showed full-thickness involvement as well. These observations emphasize the need for caution with thermal treatment modalities in the air-filled eye. Ophthalmoscopic examination 48 hours following vitrectomy, internal drainage of subretinal fluid, and gas fill of the vitreous cavity for diabetic macular detachment of several months' duration showed the retina to be attached. However, histopathologic examination revealed a thin layer of persistent subretinal fluid, demonstrating that it may take longer than is clinically apparent for true retinal reattachment to occur following gas tamponade of posterior retinal breaks. Prolonged gas tamponade may be necessary before retinal reattachment, with reestablishment of photoreceptor-pigment epithelial adherence, can be expected to help seal unrecognized or untreated posterior retinal breaks.