title: Late complications of hydrogel scleral buckle implants and a technique for effective removal.
abstract: OBJECTIVE
  The aim of this article is to describe complications of hydrogel (MIRAgel) scleral buckle implants that may appear many years after implantation, and to describe an effective technique to facilitate safe removal of these implants, which become extremely friable with time.
  
  
  METHODS
  Four case reports of patients with complications of hydrogel orbital implants and a technique for removal of the implants are described with review of the literature. The technique involves a conjunctival incision into each involved quadrant, followed by use of blunt instrumentation for "push" and a Frasier suction handpiece for "pull" to allow segmental removal. This technique limits the tendency of the implant to fragment, which has been a problem described with previous techniques.
  
  
  RESULTS
  Cases typically present simulating an orbital tumor or infection, with the diagnosis not immediately apparent, as was the case in 3 of 4 cases in our series. The technique we used allowed for expeditious removal and prompt recovery in all 4 patients.
  
  
  CONCLUSIONS
  Hydrogel scleral buckle implants can produce late complications that may be difficult to diagnose and manage. The "push-pull" technique described in this article facilitates effective removal, and may have implications for other types of orbital hydrogel implants as well.
authors.affiliation: General Ophthalmology, Lion's Eye Institute, Albany Medical Center, Albany, New York, USA. alynnricha@yahoo.com
authors.forename: Ayo-Lynn
authors.initials: AL
authors.lastname: Richards
authors.forename: Dale R
authors.initials: DR
authors.lastname: Meyer
mesh_terms: D000328:Adult; D000368:Aged; D020878:Device Removal / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D011102:Polyhydroxyethyl Methacrylate / Q000031:analogs & derivatives*; D011183:Postoperative Complications; D012163:Retinal Detachment / Q000601:surgery*; D012591:Scleral Buckling / Q000009:adverse effects* / Q000295:instrumentation
chemical_list: C065274:Miragel; D011102:Polyhydroxyethyl Methacrylate