Globe Loss From Intraocular Invasion of MIRAgel Scleral Buckle Components

Abstract

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.

Management of complex retinal detachment from intraocular invasion of MIRAgel-a case report

“… 7 Furthermore, evisceration was still necessary for some blind, painful eyes but failed after implementation of the procedures mentioned above, resulting in retention of the intravitreal MIRAgel. 8 Fortunately, in the present case, we removed the intruding MIRAgel through retinectomy and with the use of a fragmatome and drained the subretinal fluid with the assistance of perfluorocarbon liquid.…”

Hydrogel (Miragel®) scleral explant, late orbital complication

“…However, the rate of buckle infection was much lower with MIRAgel than with other buckling materials [10] . It's also worth mentioning that scleral invasion, and intraocular penetration of MIRAgel may occur many years after placement [11] . Crama and his colleague highlight the difficulties of removing hydrogel buckles and possible complications.…”

Spätkomplikationen nach Verwendung einer Hydrogelplombe (MIRAgel®) bei Netzhautablösung

“…In der Literatur finden sich zahlreiche Einzelfallschilderungen, aber auch Beobachtungen größerer Fallzahlen, die ein vielgestaltiges Bild von Komplikationen beschreiben. Hierbei reichen die Quellen von bulbusquerschnittverengenden Quellungsprozessen über Motilitäts-einschränkungen und sklerale Durchwanderung bis hin zum Bulbusverlust [8][9][10][11][12].…”