Abstract
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.
1
Introduction
Progressive swelling of hydrogel buckle material (MIRAgel, MIRA Inc., Waltham, MA) used previously for retinal detachment has resulted in complications including progressive intrusion of the buckle material into the eye, a blind and painful eye, anterior extrusion and exposure of the buckle through the conjunctiva and tenons layer, recurrent detachment, vitreous hemorrhage, ptosis, strabismus, optic nerve compression, granuloma formation, and buckle expansion resulting in protrusion of the globe mimicking orbital pseudotumor or orbital cellulitis. Hydrogel buckles were developed because of a potential advantage in a soft, conformable, and easily manipulated buckle material with an ability to absorb antibiotic to minimize secondary buckle infection. However, late progressive buckle swelling resulting in severe complications has led to the withdrawal of this buckle material off of the market. The complications often required complicated retinal and orbital surgeries to remove markedly swollen buckle material, which became friable and gelatinous. When intruded into the eye, this resulted in a severe posterior ruptured globe, which often resulted in progressive blindness and phthisis bulbi despite surgical intervention. Due to the concern of loss of vision in this only eye of this patient with progressive intrusion from an inferiorly placed hydrogel buckle, careful monitoring with observation every 4 months was recommended, and although gradual posterior progression was noted, surgical intervention has not been required for 30 years and with maintenance of good vision.
1.1
Case report
A 73-year-old physician presented with a history of blindness in his right eye after unsuccessful surgery for retinal detachment in 1952 at the age of 21 years. His left eye developed a macula on retinal detachment in 1990 at age 59. The retinal detachment was located inferiorly with a retinal break at 7:30. A segmental hydrogel buckle was secured inferonasal within the bed of a scleral flap and an encircling tire was placed to cover the hydrogel buckle with successful retinal reattachment. He had cataract surgery with posterior chamber intraocular lens placement in 2002 and did well until 2004, 14 years after the placement of the scleral buckle. He noted mild blurred vision. Examination at that time revealed a visual acuity of 20/20, no evidence of extrusion, an attached retina and progressive intrusion of the inferior hydrogel buckle towards the macula to within one disc diameter of the optic disc. Although there has been gradual progressive intrusion, this has not progressed into the optic nerve or the macula. The patient was able to still practice medicine for the rest of his career and still maintains stable 20/40 vision 30 years after hydrogel buckle placement ( Fig. 1 ).
