Late Swelling and Removal of Miragel Buckles

Abstract

Late swelling of Miragel buckling elements represents a common indication for buckle removal, significantly different from silicone indentations.

Globe Loss From Intraocular Invasion of MIRAgel Scleral Buckle Components

“…18 Çekiç et al described the use of the Fragmatome ultrasound for intravitreal fragmentation and aspiration with globe salvage. 5 Other surgeons manually remove the intraocular MIRAgel through a sclerostomy and repair the scleral opening, with or without vitrectomy and a tamponade agent.…”

“…1,5,13–17 In a large review of 38 eyes with MIRAgel buckles, Le Rouic et al identified two eyes with scleral bed necrosis and two eyes that perforated during removal. 18 Case reports and small case series in the English language literature describe a total of 11 eyes with scleral bed erosion with and without intraocular invasion. 1,5,13–17 In these cases, surgical correction was performed 8–20 years after MIRAgel implantation and resulted in visual acuity ranging from 20/25 to no light perception.…”

Outcomes and Complications of Hydrogel Scleral Explant Removal

“…1 More recently, however, multiple studies have been published that reveal several late complications of hydrogel scleral buckles, necessitating their removal. [2][3][4][5] The complications result from buckle swelling due to hydrolytic degradation of the material. 4,6 Common clinical indications for buckle removal include pain or discomfort, 2,7-10 external eye infl ammation, 2,7-10 presence of a palpable mass beneath the eyelid or conjunctiva 3,5 (Figs.…”

“…[2][3][4][5] The complications result from buckle swelling due to hydrolytic degradation of the material. 4,6 Common clinical indications for buckle removal include pain or discomfort, 2,7-10 external eye infl ammation, 2,7-10 presence of a palpable mass beneath the eyelid or conjunctiva 3,5 (Figs. 1, 2, and 3), exposed or migrating buckle elements, 2,3,6-9 sudden vision loss, 2 infection, 2,11 and diplopia or strabismus.…”

Extrusion of hydrogel exoplant into upper eyelid 16 years after a scleral buckle procedure

“…[2] Le Rouic and colleagues reported an average duration of 7.7 years between MIRAgel implantation and necessary explantation. [3] Kawano and colleagues reported a case of hydrogel exoplant extrusion and fragmentation into the eyelid; only part of the exoplant could be removed due to fibrous encapsulation. [4] Kearney and colleagues reported that 5 of 17 eyes (29%) developed recurrent retinal detachment after MIRAgel explantation.…”