9 Recently, long-term (7-11 years after surgery) complications have been reported in 8.5% of patients after an intrascleral buckling procedure 10 and in 1 patient after episcleral buckle, 11 related to the swelling properties of the hydrophilic implant. Hydrogel implants (originally MAI and then commercialized as MIRAgel ) seemed to be the ideal implant material 7, 8 when observed 6 to 53 months after surgery. 5, 6 These complications also are more common for patients with explants than for those with implants. 1, 2 Postoperative extrusion or infection with exposure of the scleral buckling material has been more common 3, 4 with use of silicone sponge explants (2.7%-18.0%) than with use of hard silicone explants (0.2%-1.4%). Silicone rubber was removed 1 year after surgery with symptoms of chronic infection and positive cultures, and MIRAgel implants were removed after long-term follow-up (7-10 years), showing positive cultures in only 20%.Ĭonclusion Periodic long-term follow-up previously recommended for use of other materials also must be recommended for MIRAgel use because of long-term alterations in its chemical composition and eventual swelling of material.ĬOMPLICATIONS after retinal detachment surgery that lead to removal of the scleral buckling element have been reported. Silicone sponge needed to be removed a short time after surgery, showing symptoms of acute infection and positive cultures. Silicone sponge (3 of 32 patients) was more frequently removed than was silicone rubber (2 of 360 patients) or MIRAgel (5 of 386 patients). Removal of the implant was necessary in 10 patients (1.3%). Results A total of 757 patients were included in the study. Care was taken in buckling element removal, considering the material used for scleral buckling (detailed operative note), duration of the buckle, cause of removal, and culture of the removed element. Symptoms and signs of infection or rejection were considered. Methods Medical reports were reviewed of 805 patients with cryotherapy and episcleral buckle for rhegmatogenous retinal detachment who were operated on by 1 of us (M.R.-P.) between March 1984 and December 1997. Objective To compare long-term complications of silicone sponge, silicone rubber, and MIRAgel used as episcleral buckling elements. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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