MIRAgel: the immunohistochemical expression of CD3, CD34, and CD68 in the surrounding capsule

Histopathology of Hydrolyzed MIRAgel Scleral Buckles

Introduction

The goal of this study was to histopathologically evaluate the appearance of degrading MIRAgel scleral buckles so that they can be reliably distinguished by ophthalmic pathologists from other foreign materials.

Methods

Retrospective chart review and histopathologic study with special stains, including Alcian blue, periodic acid-Schiff, Masson's trichrome, and Perls' Prussian blue for iron, of 4 cases between 2017 and 2019.

Results

Hydrolyzed MIRAgel scleral buckles from 4 patients had a consistent histopathologic appearance. They had a honeycomb structure with the walls of the lattice ranging from distinct to poorly defined. The walls of the lattice were positive for Alcian blue, while the contents of each cell contained periodic acid-Schiff-positive material. Other special stains were not as valuable in highlighting the material.

Discussion

Although the capsules of MIRAgel scleral buckles have been well studied, the material itself has not been. While clinical history and radiographic appearance are often diagnostic of a hydrolyzed MIRAgel scleral buckle, there are instances of preoperative ambiguity where histopathologic confirmation can be useful.

Conclusions

MIRAgel scleral buckles have a distinct histopathologic appearance that can be readily distinguished from that of other foreign materials.

Long term observation of hydrogel buckle intrusion without vision loss

Hydrogel buckle intrusion due to progressive swelling is a known complication, which usually requires surgical intervention due to vitreous hemorrhage, retinal detachment, or progressive encroachment into the optic nerve or macula. Hydrogel buckle surgery with successful retinal detachment repair was performed in this one-eyed physician in 1990, and there was slow progressive intrusion towards the macula and optic nerve without surgical intervention for 30 years and with visual acuity maintained at 20/40.

Management of complex retinal detachment from intraocular invasion of MIRAgel-a case report

Purpose

To retrospectively report a case of complex retinal detachment secondary to an intraocular episcleral hydrogel explant (MIRAgel, MIRA Inc., Waltham, MA, USA) invasion.

Observations

The severe vitreous inflammation, shifting nature of the subretinal fluid, and absence of proliferative vitreopathy 2 months following multiple surgeries for removal of fragmented MIRA gel in the present case made the diagnosis of complex retinal detachment. With the assistance of the fragmatome and Perfluorocarbon, the subretinal MIRA gel, and turbid, yellowish subretinal fluid were removed successfully. The retina was re-attached without recurrence.

Conclusions and importance

By using the pars plana ultrasonic fragmatome, the intraocular MIRAgel was able to be removed while maintaining the integrity of the retina and globe.