Abstract
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.
Highlights
MIRAgel® (MIRA, Waltham, MA, USA) is a hydrogel scleral buckle that was first introduced in 1979 as an alternative to silicone explants to treat rhegmatogenous retinal detachments [1]
Hydrogel scleral buckles (MIRAgel®) were popularised in the 1980s as they were perceived as an improvement upon the prior available silicone buckles [14]
The expansion of the hydrogel implant was linked to hydrolytic degradation of multiple esters in the material, causing swelling and a change in its consistency to a more friable, gel-like object [16]
Summary
MIRAgel® (MIRA, Waltham, MA, USA) is a hydrogel scleral buckle that was first introduced in 1979 as an alternative to silicone explants to treat rhegmatogenous retinal detachments [1]. There were subsequent reports of the hydrogel undergoing hydrolytic degradation with progressive swelling of the explant causing severe complications, such as globe compression and intraocular invasion, strabismus, ptosis, scleral erosion, conjunctivitis, infection around the buckle as well as significant cosmetic problems [3,4,5,6,7,8,9,10,11,12]. These complications necessitated surgical removal of the buckle, which could cause concerns of retinal re-detachment and intraoperative scleral rupture [5].
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