Scleral Penetration by a Cryoprobe in Primary Buckling Surgery for Traumatic Retinal Detachment: A Case Report.

Introduction: Scleral rupture during intraocular surgery is a rare but serious complication, most often associated with prior buckling, scleritis, trauma, or high myopia. We report a unique case of scleral penetration by a cryoprobe during primary buckling surgery for traumatic rhegmatogenous retinal detachment (RRD). Case Presentation: A 59-year-old man developed localized RRD 9 days after sustaining blunt ocular trauma from a baseball. During surgery, an area of scleral thinning was noted between the lateral and superior rectus muscles. While performing cryocoagulation for the causative retinal tear, the tip of the cryoprobe penetrated the sclera, resulting in a 4-mm L-shaped rupture beneath the superior rectus muscle. The rupture was successfully repaired with sutures, a silicone sponge, and intravitreal SF6 injection, followed by additional pars plana vitrectomy and photocoagulation for persistent subretinal fluid. Six months postoperatively, the retina remained attached without proliferative vitreoretinopathy, and visual acuity improved to better than 20/20. Conclusion: This case illustrated that blunt ocular trauma can cause occult scleral fragility, even without preoperative signs, emphasizing the need for meticulous intraoperative assessment to avoid rare iatrogenic complications.