Purchase this article with an account.
Tal Rubinstein, Julian D Perry, Rao Chundury; Evisceration of Eyes with Intraocular Erosion of MIRAgel Scleral Buckles. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4755.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
MIRAgel (hydrogel) scleral buckles have been associated with significant complications such as orbital inflammation, intraocular erosion, and endophthalmitis. Patients with intraocular erosion in a painful, blind eye may benefit from evisceration to remove the intraocular contents and the inciting MIRAgel material. We explore preoperative and intraoperative findings of such eviscerations and their postoperative course. Further, we define a method of transocular-approach orbitotomy to remove orbital components of the scleral buckle through the eviscerated eye.
This is an IRB approved, retrospective case series of consecutive patients who underwent evisceration at the Cleveland Clinic between the years 2000 and 2014. Patients were included if they had concurrent explantation of MIRAgel scleral buckle material; all other patients were excluded. Patient files were searched for age, gender, laterality, pre-operative findings, pre-operative ocular imaging, intraoperative surgical procedure and findings, post-operative findings, complications, and duration of follow up.
Preliminary review identified four patients who met criteria. All were female with an average age of 65.25 years (range 55-80). All patients had blind, painful eyes; one also had endophthalmitis. Two of four pre-operative B-scans identified intraocular erosion of the scleral buckle. One evisceration was performed in 2002, the rest between 2011-2013. Three of four eviscerations were left eyes. All eviscerations identified intraocular MIRAgel components. All eviscerations were concurrently performed with orbitotomies for removal of orbital MIRAgel components, of which three were performed through a trans-ocular approach into the orbit. Average follow up time was 17.5 months (range 1-36). Two patients needed subsequent external levator resection to help with prosthetic retainment. One patient had inability to maintain prosthesis due to adhesions and foreshortened inferior fornix.
MIRAgel scleral buckles should be avoided as they may lead to devastating complications such as intraocular erosion of the material. Evisceration of blind, painful eyes with concurrent explantation of orbital MIRAgel material can be done through a transocular-approach orbitotomy, which increases efficiency and reduces additional approaches of entering the orbit. Prior scarring and extensive dissection of the MIRAgel may compromise post-surgical results.
This PDF is available to Subscribers Only