T. Hasori e.a.: "lntravitreal intrusion of an intrascleral MIRAgel buckling implant" JJO 2011 55:310  

Hasori ea rapporteren een ernstig geval van intrusie van een intrascleraal geplaatste Miragel plombe. De complicaties van een intrusie zijn meer bedreigend voor het zicht dan die van extrusie. Chirurgisch herstel van deze complicatie is moeilijk. 

MIRAgel (Medical lnstrumcnts Research Associates, Waltham. MA) is a hydrogel implant introduced as a new scleral buckling material in 1979 [1]; it is no longer used because of late complications in its extrusion and intrusion [2].
We report the case of a severe çomplication involving the use of this material in which it caused intravitreal intrusion resulting in retinal laceration and detachment 12 years after the implantation.

Case report (…)

Comment
Water-absorbing MIRAgel tends to expand gradually to cause its charasteristic late complications [1]. Compared with the extrusion complications causing pain, discomfort, rednes, protrusion of the lid and diplopia [4], the intrusion complications of the MIRAgel buckle in the subretinal space may be a more serious threat to vision [5]. In the present case the intruding MIRAgel buckle appeared in the vitreous cavity from the subretinal space through the torn retina, the repair of which can be quite challenging. Cekiç I3l reports a technique to shave the material ultrasonically using a fragmatome which did not prove succesful in the present case, probably because of the firm nature of the material. Instead we removed the whole material through a scleral wound.
When MIRAgel is used as an intrascleral buckling material, intrusion complications are more likely to dcvelop bccausc of thc thinner scleral wall under the buckle and because of its expansive nature due to the swelling, which tends to expand inwards.
Once buckling swelling found in eyes that have undergone intrascleral MIRAgel implant, the removal of thc material should be considered when necessary becausc surgical repair of the complication is difficult.