A Simple Way to Remove Miragel Explants After Long-Term Inflammation and Extrusion

Chalioulias, Konstantinos; Nachiketa, Acharya; Scott, Rob

doi:10.1097/icb.0b013e318158de8e

Cited by 5 publications

(3 citation statements)

References 5 publications

(4 reference statements)

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“…Although they managed to remove the scleral buckle successfully in four patients using this technique, we found this challenging, and the patient in our case suffered late complications related to the remaining explant fragments. Several other techniques were proposed in the literature, including the pulling on the implant with a cryoprobe [ 18 ], floating the implant out of the capsule with balanced salt solution [ 19 ], consolidating the implant with boric acid to facilitate removal in one piece [ 20 ], or most recently, the modified suction-assisted removal technique [ 21 ]. It is uncertain whether which technique works best.…”

Section: Discussionmentioning

confidence: 99%

Chronic Macular Oedema as a Late MIRAgel-Related Complication

Chean

Lim

Mudhar

et al. 2021

Vision

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Background: MIRAgel® (MIRA, Waltham, MA, USA) is a hydrogel scleral buckle introduced in 1979 to treat rhegmatogenous retinal detachments. Its use was discontinued because late complications that require surgical removal were reported. Methods: Case report. Results: We report a case of left eye MIRAgel® buckle surgery 28 years ago presenting with a tender palpable erythematous swelling at the lower lid, with marked conjunctival chemosis and progressive ophthalmoplegia. Imaging revealed a large, well-defined, horseshoe-shaped lesion in the extraconal space of the left orbit with globe distortion, with histological confirmation of an expanded hydrogel buckle. He recovered well following removal of the explant but developed chronic macular oedema a year later, which persisted despite sub-Tenon’s triamcinolone injections. Repeat imaging demonstrated remaining hydrogel explant. Macular oedema settled well upon successful surgical removal with no recurrence to date. Conclusion: Our case is the first to describe macular oedema as a late MIRAgel-related complication, with complete removal of the explant being the definitive treatment. Macular oedema indicates postoperative inflammation secondary to the remaining explant fragments. Given the friability of hydrolysed MIRAgel®, we recommend ophthalmologists to warn patients regarding the possibility of further inflammation in the globe or the orbit in case of incomplete removal.

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Section: Discussionmentioning

confidence: 99%

Chronic Macular Oedema as a Late MIRAgel-Related Complication

Chean

Lim

Mudhar

et al. 2021

Vision

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“…13,15,16 In addition to manual dissection, the friable and fragmented extraocular components have been removed by the cryoprobe, 14,21 suction, 22 boric acid, 23 or outward flotation of the buckle using balanced salt solution. 24 We recommend initial surgical attempt to repair the open globe and to extract intraocular and extraocular MIRAgel, reserving evisceration or enucleation only for cases of a blind, painful eye. This study’s methodology involved only cases of evisceration due to surgeon preference, which may have resulted in an underrepresentation of cases.…”

Section: Discussionmentioning

confidence: 99%

Globe Loss From Intraocular Invasion of MIRAgel Scleral Buckle Components

Rubinstein

Choudhary²,

Modi³

et al. 2016

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Purpose To describe intraocular invasion of MIRAgel scleral buckles requiring evisceration. Methods This is an IRB-approved retrospective consecutive case series of eyes requiring evisceration secondary to intraocular intrusion of MIRAgel implants performed at the Cole Eye Institute from 2000 to 2014. Charts were reviewed for age at surgery, gender, laterality, time between MIRAgel placement to evisceration, preoperative examination and imaging results, intraoperative findings, postoperative complications, and duration of follow-up. Results Five eyes of five patients underwent evisceration due to a blind, painful eye secondary to MIRAgel expansion. The mean time between MIRAgel placement and evisceration was 21 years (range: 17 to 30 years). Preoperative ultrasound identified intraocular MIRAgel in 3/5 cases; however, intraocular MIRAgel was identified during surgery in all 5 cases. A transocular-approach orbitotomy was performed at the time of evisceration in an effort to remove the MIRAgel. Post-operative complications included ptosis and inability to retain an ocular prosthesis. No cases of orbital implant extrusion occurred. Conclusion Scleral invasion and intraocular penetration of MIRAgel may occur decades after placement. This may result in a blind, painful eye requiring evisceration and orbitotomy to remove residual material. Suspicion of intraocular penetration of implant should be high in blind, painful eyes. Surgical removal can be difficult due to MIRAgel fragmentation. Conjunctival insufficiency may result in the need for further surgery after evisceration.

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“…However, residual fragments are often left behind with this approach, leading to repeated removal procedures. Several alternative techniques and devices have been proposed, for example, pulling on the implant with a cryoprobe 7 or a suction device 8 to assist in the pushing maneuvers, floating the implant out of the capsule with balanced salt solution, 9 or consolidating the implant with boric acid to facilitate removal in one piece. 10 We herein describe a modified suction-assisted removal technique that, in our opinion, is faster, safer, and easier to perform than previous methods.…”

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confidence: 99%