title: Globe Loss From Intraocular Invasion of MIRAgel Scleral Buckle Components.
abstract: OBJECTIVE
  To describe intraocular invasion of MIRAgel scleral buckles requiring evisceration.
  
  
  METHODS
  This is an Institutional Review Board-approved retrospective consecutive case series of eyes requiring evisceration secondary to intraocular intrusion of MIRAgel implants performed at the Cole Eye Institute from 2000 to 2014. Charts were reviewed for age at surgery, gender, laterality, time between MIRAgel placement and evisceration, preoperative examination and imaging results, intraoperative findings, postoperative complications, and duration of follow up.
  
  
  RESULTS
  Five eyes of 5 patients underwent evisceration due to a blind, painful eye secondary to MIRAgel expansion. The mean time between MIRAgel placement and evisceration was 21 years (range: 17-30 years). Preoperative ultrasound identified intraocular MIRAgel in 3 of 5 cases; however, intraocular MIRAgel was identified during surgery in all 5 cases. A transocular-approach orbitotomy was performed at the time of evisceration in an effort to remove the MIRAgel. Postoperative complications included ptosis and inability to retain an ocular prosthesis. No cases of orbital implant extrusion occurred.
  
  
  CONCLUSIONS
  Scleral invasion and intraocular penetration of MIRAgel may occur decades after placement. This may result in a blind, painful eye requiring evisceration and orbitotomy to remove residual material. Suspicion of intraocular penetration of implant should be high in blind, painful eyes. Surgical removal can be difficult due to MIRAgel fragmentation. Conjunctival insufficiency may result in the need for further surgery after evisceration.
authors.affiliation: *Cole Eye Institute, Cleveland Clinic Foundation, Ohio, U.S.A.
authors.forename: Tal J
authors.initials: TJ
authors.lastname: Rubinstein
authors.forename: Maria M
authors.initials: MM
authors.lastname: Choudhary
authors.forename: Yasha S
authors.initials: YS
authors.lastname: Modi
authors.forename: Justis P
authors.initials: JP
authors.lastname: Ehlers
authors.forename: Julian D
authors.initials: JD
authors.lastname: Perry
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017234:Eye Evisceration / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D015745:Granuloma, Foreign-Body / Q000139:chemically induced / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011102:Polyhydroxyethyl Methacrylate / Q000009:adverse effects / Q000031:analogs & derivatives*; D019736:Prostheses and Implants / Q000009:adverse effects*; D012086:Reoperation; D012189:Retrospective Studies; D012591:Scleral Buckling / Q000009:adverse effects*
chemical_list: C065274:Miragel; D011102:Polyhydroxyethyl Methacrylate