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In their recent article, Kelley et al.1 state that ultrasound-guided cryotherapy provides a noninvasive, inexpensive treatment alternative for retinal tears obscured by vitreous hemorrhage.
We know that in patients who have retinal tears and detachment, lattice degeneration is of major significance. Breaks in lattice degeneration occur primarily as round holes within the lattice or as horseshoe tears at the edge of the lattice. Management includes appropriate sealing of these areas in addition to the holes or breaks. Moreover, an adequate margin of surrounding retina should be treated and the treatment should extend to the ora serrata.2 It is impossible to detect the areas of the lattice degenerations obscured by vitreous hemorrhage and atrophic holes in lattice using ultrasonography, although flap tears can be detected. This management would not be appropriate if the tear was located at the edge of a lattice. Misplaced, insufficient, or excessive cryoapplication can cause unsatisfactory results by not closing the holes and lattice areas beside the flap tear. Pigment dispersion occurs when the tears are used excessively, and this also increases the development of proliferative vitreo retinopathy (PVR),3'4 which eventually necessitates vitreoretinal intervention. However, functional outcome still may not be satisfactory if the macula is affected. Additionally, cryoapplication seems to increase the risk of PVR in eyes with vitreous hemorrhage.5
This procedure is presented as noninvasive, inexpensive, and practical....