Mazzoli ea, Use ofself-expanding, hydrophilic osmotic expanders (hydrogel) in the reconstruction of congenital clinical anophthalmos, Current Opinion in Ophthalmology. 15(5):426-431, October 2004  

Mazzoli e.a. besteden in dit artikel aandacht aan de onbedoelde of onverwachte lange termijn gevolgen van nieuwe materalen zoals de Miragel plombes (retinal buckling elements).naar aanleiding van de recente stortvloed van meldingen van lange termijn complicaties bij hydrogels. De lange tijdsduur – 10 jaar of langer – tussen de oorspronkelijke toepassing en het ontstaan van de complicaties en het feit dat de MIRAgel midden negentiger jaren van de markt is gehaald kunnen leiden tot verkeerde disgnoses wanneer de arts onbekend is met de eerdere operatie of met het toen gebruikte materiaal.

Potential drawbacks
As with any new material or technique, there can be potential for unintended or unexpected consequences in the long term. The fly in this particular soup is the recent spate of reports of complications of prior hydrogel applications in the orbit, to whit, retinal buckling elements made of MIRAgel (MIRA, Waltham, MA) and its precursor, MAl, popular products introduced in the late 1970s [27,28,29,30,31-38]. Reputed advantages of these produets were the following: less likelihood for extrusion or erosion because of the material's softness and elasticity: less likelihood of buckle infections because of its lack of dead-air spaces and the fact that it could be saturated in antibiotic solution (which it would gradually release thereafter); the degree of swelling could be controlled by controlling hydration; and, it stimulated the formation of a surrounding pseudocapsule [27,28,29.30]. In fact, most of these claims were borne out clinically, at least in the short-term [29,35]. Unfortunately, over the long term (10+ years), complications of late hydrogel breakdown were recognized. attributed to uncontrolled swelling of the material beyond its initial size [28,29.31,33]. In fact, the long time lapse between implantation and development of complications may lead to initial misdiagnosis of the condition, particularly if the patient presents to a clinician unfamiliar with either the prior surgery performed, or the material used [31]. Indeed, since withdrawal of MIRAgel from the market in the mid 1990s, many novice ophthalmologists are no longer historically familiar with the material at all. There are now reports of buckle extrusions, intraocular erosion and migration, progressive limitation of motility, intraorbital fibrosis and mass effect, pain, foreign body granuloma formation, and inflammatory orbital pseudotumor [27,28,29,30,31,32-38]. Attempts at removing the material are frustrating, because the hydrogel becomes very friable with age, becomes semisolid, and fragments easily between the forceps. Some advocate using cryo or curettage to help remove the pieces [29,30,32].