The authors recommend setting up all materials prior to administration of anesthesia. Ensure all equipment, including cryotherapy, millipore filter, gas and indirect laser are available and functional. Label syringes to avoid confusion.
There are two options for retinopexy: cryotherapy (1-step procedure) or laser (two-step procedure). Cryotherapy is applied prior to injection of the gas bubble. Laser is applied following injection of the gas bubble, once the retina has reattached. Laser retinopexy to lattice or breaks in attached retina is applied prior to the gas bubble injection. Cryotherapy has the advantages of being better able to localize the break(s) than post-gas indirect retinal laser and an ability to be applied even when subretinal fluid is present. It can also aid in identifying small breaks missed during clinical examination and be beneficial in aphakic patients or patients with a suboptimal view of the posterior segment.
The theoretical disadvantage is a higher risk of proliferative vitreoretinopathy (PVR) with heavy cryotherapy when retinal pigment epithelial (RPE) cells are liberated into the vitreous cavity and a delay in achieving chorioretinal adhesion. In general, the authors prefer laser. If cryotherapy is used laser can be used to augment the retinopexy.