Li ea, Miragel explant fragmentation 10 years after sc1eral buckling surgery, Eye (2003) 17, 248-250

In 2003 waarschuwen ook Li ea. (Liverpool) voor de moeilijke verwijdering van de MIRAgel explants vanwege de desintegratie ervan. Het is kennelijk een zeer langzaam proces, omdat de typische Miragel complicaties pas 7-10 jaar na de oorspronkelijke toepassing ervan aan het licht komen. Omdat MIRAgel explants op uitgebreide schaal zijn gebruikt dienen afdelingen oogheelkunde zich bewust te zijn van latere complicaties.

Long-term complications are known to be associated with hydrogel explants.^1,2,3,4 We would like to present a patient with severely restricted eye movements 10 years following the use of Miragel explant (from MIRA, 87 Rumford Avenue, Waltham, MA 02454, USA).

Case report
A 66-year-old man had two scleral buckling surgeries for a right rhegmatogenous retinal detachment 10 years previously. He was referred for increasing binocular diplopia over the past 12 months.
On examination, his visual acuity was 6/18 OD and 6/12 OS. There was a large swelling over the superotemporal aspect of the right globe. 
On palpation, it was not possible to reach the posterior extent of this swelling. The eye was hypotropic and esotropic, and the extraocular movements were limited in all directions, especially abduction and elevation. (…)

Miragel explants were subsequently withdrawn because of late complications.^1,2,3,4 These include erosion into the globe, extrusion of the explants and progressive diplopia. The material had been shown to be structurally unstable and this led to excessive water absorption, swelling and disintegration.¹ This process must be a very slow one, as typically many of these complications only appear 7-10 years after the initial scleral buckle operation ^1,2,3,4
Comment
Using scissors and forceps in the conventional manner, the removal of Miragel may be difficult: as the explants disintegrate when grasped by instruments. In our patient, the explant was associated with massive periocular fibrosis and extensive dissection was required to free the globe from its mechanical restriction.
Our case illustrated that the symptoms can be slowly progresslve and that some complications tended to be delayed for many years. We may only be starting to see a number of these cases in this country, even though the explants were withdrawn some years ago. Where Miragel explats had been used extensively in the past, eye units should be aware of the possibility of late complications.