The effect of retinal cryoapplication on the vitreous.

Abstract

The effect of retinal cryopexy on the vitreous was studied morphologically in an animal model. The retina and vitreous were frozen with single cryolesions on one eye and 24 contiguous cryolesions on the contralateral eye in 16 rabbits. The cryoprobe was applied to the sclera from 3 mm to 6 mm posterior to the limbus at -60 degrees C until ophthalmoscopically visible whitening occurred. Two animals were killed on the first day; the third day; after 1, 2, and 4 weeks; and after 2, 3, and 6 months after surgery. The eyes were enucleated and prepared by the celloidin embedding method. Each 200-microgram section was examined by light microscopy. Areas of the specimens were dissected and studied by scanning and transmission electron microscopy. Single cryolesions did not have a significant generalized effect on the vitreous. Evidence of local collagen destruction and dispersion of cells was found near the area of cryoapplication. Contiguous cryoapplication led primarily to increased density in the vitreous and subretinal edema. The vitreoretinal border was invaded by mononuclear cells containing pigment granules. Thickened collagen fibers were attached to the coagulated retina in a perpendicular manner and traversed the whole vitreous body. After 4 weeks the increased vitreous density slowly diminished, and preretinal capillaries surrounded by vitreous collagen started to proliferate from the vitreoretinal interface. After 6 months central vitreous collagen fibers looked normal. In the area of cryoapplication, vitreoretinal membrane formation had occurred. Single cryolesions have no significant effect of the vitreous. Multiple cryolesions lead to neovascularization soon after the procedure (1 month) and membrane formation later (6 months after the procedure). This supports the concept that the extensive use of cryopexy in human retinal surgery could contribute to the development of proliferative vitreoretinopathy.