Cryoextraction of Episcleral Miragel® Buckle Elements: A New Technique to Reduce Fragmentation

Rouic, J F Le; Bejjani, R.A.; Azan, F.; Bettembourg, O.; Renard, G; Chauvaud, D

doi:10.3928/1542-8877-20020501-13

Cited by 19 publications

(2 citation statements)

References 6 publications

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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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“…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%