Long-term complications of silicone and hydrogel explants in retinal reattachment surgery.

OBJECTIVE To compare long-term complications of silicone sponge, silicone rubber, and MIRAgel used as episcleral buckling elements. 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. Average follow-up was 76 months. Symptoms and signs of infection or rejection were considered. 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. RESULTS A total of 757 patients were included in the study. Removal of the implant was necessary in 10 patients (1.3%). Silicone sponge (3 [9%] of 32 patients) was more frequently removed than was silicone rubber (2 [0.6%] of 360 patients) or MIRAgel (5 [1.3%] of 386 patients). Silicone sponge needed to be removed a short time after surgery, showing symptoms of acute infection and positive cultures. 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%. CONCLUSION 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.