![]() At each follow-up visit, the patient was questioned about pain, ocular redness, and ocular discharge. Patients made follow-up office visits 1, 3, 6, 12, 24, and 36 months after surgery and then annually or biannually. 13 Systemic antibiotic drugs were used after surgery for 6 days, and local antibiotic drugs were used for 3 weeks. Gentamicin sulfate was used to soak the buckling elements before implantation and for injection into the Tenon space after closure, following the procedure of McPherson and Moura. In some patients, drainage of the subretinal fluid or intravitreous balanced salt solution or air injection was performed. ![]() When cerclage was required, a 240 solid silicone band was used. Different material sizes and lengths were used, as were different surgical procedures (segmental-localized indentation, segmental indentation associated with cerclage, and broad indentation for 360°) ( Table 1, Table 2, and Table 3). 12 The materials used were silicone sponge, solid silicone rubber, and MIRAgel. The operative technique was a modified Custodis operation, using cryopexy to the edges of the breaks and an explant compressed over full-thickness sclera. No preoperative local antibiotic drugs were used. Only patients with up-to-date follow-up information and signed informed consent forms were included in the study. Nine patients were lost during follow-up. The excluded 39 detached eyes did not show symptoms or signs of implant rejection, and combined surgeries were considered to reattach the retina (exclusion criteria). The included 757 patients had complete reattachment of the retina 6 months after surgery. Only single procedures (805 patients) were considered, without other intraocular or combined surgery. Medical reports were reviewed of patients with cryotherapy and episcleral buckles 12 for rhegmatogenous retinal detachment who were operated on at the Hospital Clínico San Carlos, Madrid, Spain, by 1 of us (M.R.-P.) between March 1984 and December 1997. The aim of our study was to compare long-term complications of the 3 materials (silicone sponge, silicone rubber, and MAI or MIRAgel hydrogel) used more commonly as episcleral buckling elements. 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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