Enrico Bertelli, Paolo Santorum, Italy

Background:
Episcleral explants made of hydrogel (methylacrylate-2-hydroxyethylacrylate, MIRAgel, Medical Instruments Research Associates Inc., Waltham, MA) have been widely used as scleral buckles as an alternative to silicone buckles. These sponge-like material presented some theorical advantages: it was soft and elastic, therefore easier to manipulate, and gentler on the sclera intraoperatively; it could be soaked in anti-infective solutions, possibly reducing the incidence of scleral buckle infection; finally, it was known that the material would swell a little after surgery, but this was thought to be desirable because theoretically it could help keep the retina reattached. What was not known, was that the swelling would progress. Progressive enlargement caused diplopia, ptosis, buckle exposure with or without infection, scleral erosion, and significant cosmetic problems. Purpose: A new surgical technique is described, that simplifies the removal of MIRAgel scleral buckle explants.

Methods:
It is a retrospective interventional case series. In the presented technique we use a Frazier suction device to remove the MIRAgel friable material by aspiration through its cannula. In case the material is too dense for direct aspiration, the cannula tip is used to gently scrape it: scraping crumbles the buckle material and aspiration becomes possible.

Results:
Four MIRAgel scleral buckles were removed, 25 to 30 years after implantation, because of extrusion with infection (n=2 radial buckles) or disfiguring swelling of the eyelids (n=2 circuferential buckles). After surgery, all patients had full resolution of their symptoms without any additional intervention. Intraoperative, circumscribed scleral rupture occurred in 1 case, in an area of extreme preexistent scleral erosion.

Conclusions:
Aspiration through a Frazier suction cannula facilitates the removal of MIRAgel scleral buckle explants. Instead of trying to grasp or luxate the friable material, it is removed in place by means of vacuum. This technique seems to be safer, faster and easier to perform than other previously described methods.

Contact Details:

Enrico Bertelli
Ophthalmic Department, San Maurizio Regional Hospital
Bolzano
Italy
Cell Phone : 00393409191017
Work Phone : 00390471908605
Email : enrbertelli@gmail.com