Implante de Miragel, a propósito de 3 casos / Miragel implant, apropos of 3 cases

Se exponen las consecuencias a largo plazo del uso del implante de miragel como tratamiento del desprendimiento de retina. Se presentan las características durante la cirugía y el postoperatorio de la explantación de este tipo de implante en 3 pacientes que acudieron a la consulta de Retina del Hospital Oftalmológico ®Amistad Argelia Cuba¼ en Djelfa, Republica Popular y Democrática de Argelia, con el diagnóstico de cirugía convencional de retina con implante de miragel realizado en Francia en la primera mitad de la década del 90. Predominó el disconfort por la limitación de los movimientos oculares. Dos casos presentaban exposición del implante y sepsis periocular. A los tres casos se les retiró el implante que se fragmentaba con mucha facilidad y dificultaba su extracción, además se encontró marcada distensión muscular que se recuperó paulatinamente en el postoperatorio al igual que los movimientos oculares

The long-term consequences of the use of Miragel implant as treatment of retinal detachment were set forth in this article. The characteristics of the Mirage explant during surgery and postoperatively in three cases, who went to the retinal service of "Amistad Algeria-Cuba" ophthalmological hospital in Djelfa, Democratic People's Republic of Algeria, were presented. They had been operated on by conventional retinal surgery and implanted a Mirage implant in France in the first half of the 90's. The predominant symptom was discomfort due to limited eye movements. Two cases presented with implant exposure and periocular sepsis. The implants were removed from the three patients; they fragmented very easily and made their extraction difficult in addition to marked muscular distension. The latter gradually disappeared and the eye movements were recovered in the postoperative phase

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

Sixteen years after scleral buckle surgery with a hydrogel episcleral exoplant, a 43-year-old woman presented with progressive binocular diplopia, ptosis, and an expanding mass in her upper eyelid. She underwent surgical removal of the hydrogel exoplant through an anterior approach. The exoplant proved to be friable, fragmented, and encapsulated in a fibrous tissue; the exoplant was removed in its entirety. Postoperatively, the eyelid mass resolved, while her diplopia and ptosis improved slightly.

Late Complications after Successful Scleral Buckling Surgery Using Hydrogel Buckles

PURPOSE: To report late complications of hydrogel buckles (MIRAgel explant, MIRA, Waltham, U.S.A.) from use in scleral buckling surgery for retinal detachment. METHODS: The clinical records of 10 patients who underwent MIRAgel removal between January 1993 and March 2005 were reviewed. Preoperative computerized tomography (CT) scans were examined in three patients with suspected orbital mass. The unused and removed MIRAgel were examined by scanning electron microscopy (SEM). RESULTS: The average interval to MIRAgel removal was 9.4 years. Patients presented with complaints of restricted gaze (6 cases), exposed buckle (6 cases), palpebral mass (5 cases), and periorbital swelling (3 cases). Initially, 4 patients were misdiagnosed with orbital tumor or cellulitis. MIRAgel were removed by transconjunctival or skin incision, (totally in 7 eyes and partially in 3 eyes). CT scans showed circumferential soft tissue mass surrounding the globe with a peripherally-enhancing rim. SEM showed that unused samples had a smooth surface and uniformly sized micropores. The surfaces of the removed MIRAgel were uneven, with micropores that were distorted in shape and irregular in size. CONCLUSIONS: Because late complications with MIRAgel have various clinical aspects, complete history taking and ophthalmic examination are essential in making an accurate diagnosis and choosing proper treatment. Patients with MIRAgel should be followed up periodically, and its timely removal should be considered.

Late Complications after Successful Scleral Buckling Surgery Using Hydrogel Buckles

PURPOSE: To report late complications of hydrogel buckles (MIRAgel explant, MIRA, Waltham, U.S.A.) from use in scleral buckling surgery for retinal detachment. METHODS: The clinical records of 10 patients who underwent MIRAgel removal between January 1993 and March 2005 were reviewed. Preoperative computerized tomography (CT) scans were examined in three patients with suspected orbital mass. The unused and removed MIRAgel were examined by scanning electron microscopy (SEM). RESULTS: The average interval to MIRAgel removal was 9.4 years. Patients presented with complaints of restricted gaze (6 cases), exposed buckle (6 cases), palpebral mass (5 cases), and periorbital swelling (3 cases). Initially, 4 patients were misdiagnosed with orbital tumor or cellulitis. MIRAgel were removed by transconjunctival or skin incision, (totally in 7 eyes and partially in 3 eyes). CT scans showed circumferential soft tissue mass surrounding the globe with a peripherally-enhancing rim. SEM showed that unused samples had a smooth surface and uniformly sized micropores. The surfaces of the removed MIRAgel were uneven, with micropores that were distorted in shape and irregular in size. CONCLUSIONS: Because late complications with MIRAgel have various clinical aspects, complete history taking and ophthalmic examination are essential in making an accurate diagnosis and choosing proper treatment. Patients with MIRAgel should be followed up periodically, and its timely removal should be considered.

Diplopia and Periorbital Mass Associated with Miragel Buckling Explant

A 28-year-old female presented with a palpable mass lesion on the superonasal aspect of her right globe and she had a progressive diplopia. She had a scleral encircling surgery with a Miragel explant (MIRA, Waltham, Mass, USA) for the tractional retinal detachment associated with pars planitis 9 years previously. On examination, she revealed restricted eye movements of her right eye. The magnetic resonance imaging documented a swelling of the Miragel explant that mimicked a periorbital mass lesion. The Miragel explant was removed and fragmentation of the explant was found intraoperatively. The removed Miragel explant was examined by a scanning electron microscopy, and this demonstrated a disintergrated and swollen structural composition of the Miragel explant. Postoperatively, her extraocular movement was almost restored and the retina remained well attached. Alterations in the structural composition of the Miragel explant results in an excessive swelling that causes a restriction of the extraocular movement, and this can mimick a periorbital mass lesion.