Removal of MIRAgel Scleral Buckle Implants: The Direct Aspiration Technique

Santorum, Paolo; Vitto, Antonia Maria Luce De; Bertelli, Enrico

doi:10.1097/iae.0000000000002620

Cited by 5 publications

(4 citation statements)

References 10 publications

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“… 2 However, the procedure is difficult because of the friable nature of the degrading MIRAgel; in addition, sclera erosion and thinning underneath the material makes scleral perforation likely to occur before or during removal, which makes MIRAgel removal even more challenging. 2 , 3 Crama and Klevering previously reported an incidence of intraoperative scleral perforation of 11% in 467 consecutive MIRAgel cases. 2 The presence of an active ocular infection and a history of more than one preceding procedure were significantly associated with a higher risk of scleral perforation during the removal procedure in their study.…”

Section: Discussionmentioning

confidence: 97%

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

Hsieh

Chen

2021

American Journal of Ophthalmology Case Reports

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Purpose To retrospectively report a case of complex retinal detachment secondary to an intraocular episcleral hydrogel explant (MIRAgel, MIRA Inc., Waltham, MA, USA) invasion. Observations The severe vitreous inflammation, shifting nature of the subretinal fluid, and absence of proliferative vitreopathy 2 months following multiple surgeries for removal of fragmented MIRA gel in the present case made the diagnosis of complex retinal detachment. With the assistance of the fragmatome and Perfluorocarbon, the subretinal MIRA gel, and turbid, yellowish subretinal fluid were removed successfully. The retina was re-attached without recurrence. Conclusions and importance By using the pars plana ultrasonic fragmatome, the intraocular MIRAgel was able to be removed while maintaining the integrity of the retina and globe.

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Section: Discussionmentioning

confidence: 97%

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

Hsieh

Chen

2021

American Journal of Ophthalmology Case Reports

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“…A “push-pull” technique using a squint hook or freer periosteal elevator has been suggested. 12 The authors utilized the direct aspiration technique with a Frazier suction cannula, as was described by Santorum et al 13 This technique is advantageous for friable materials, whereby the fragmented smaller pieces become more amenable to direct aspiration.…”

Section: Discussionmentioning

confidence: 99%

Orbital and Sinonasal Complications of Hydrogel Scleral Buckle: A Case Report

Tong

Smith

Gout

et al. 2022

Ophthalmic Plastic &Amp; Reconstructive Surgery

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The hydrogel scleral buckle is a hydrophilic implant that is characterized by progressive expansion and can present with secondary orbital changes. The authors present a unique case of hydrogel-induced erosion of the orbital roof into the frontal sinus, with formation of a sinoorbital communication that resulted in frontal sinusitis and adjacent cerebritis. The hydrogel material is radiologically characterized as a fluid-filled hypertense T2 mass with rim enhancement and peripheral calcification. Awareness of late orbital complications from the hydrogel material is important to distinguish this entity from other mimicking orbital pathologies.

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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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Removal of MIRAgel Scleral Buckle Implants: The Direct Aspiration Technique

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 5 publications

References 10 publications

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

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

Orbital and Sinonasal Complications of Hydrogel Scleral Buckle: A Case Report

Chronic Macular Oedema as a Late MIRAgel-Related Complication

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