Pneumatic retinopexy as a treatment for rhegmatogenous retinal detachment in pediatric patients meeting PIVOT criteria.

OBJECTIVE: To report the results of pneumatic retinopexy (PnR) as the initial treatment in pediatric patients with rhegmatogenous retinal detachment (RRD) fulfilling The Pneumatic Retinopexy versus Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomized Trial (PIVOT) criteria. DESIGN: A retrospective multicentre study. PARTICIPANTS: Pediatric patients who underwent outpatient PnR as the initial treatment for RRD from January 2006 to July 2019 who met PIVOT criteria. METHODS: Patients underwent anterior chamber paracentesis followed by intravitreal injection of sulfur hexafluoride (SF6) gas. Either laser retinopexy was performed following retinal reattachment or cryopexy was performed at the time of the initial procedure. RESULTS: A total of 20 eyes of 20 consecutive patients met inclusion criteria and were included in this study. Mean (± standard deviation [SD]) follow-up time was 42.2 ± 38.0 months. Mean patient age was 14.4 years (range, 9-18). There were 17 males and 3 females. The mean (± SD) logMar visual acuity improved from 0.73 ± 0.82 (Snellen equivalent approximately 20/100) to 0.37 ± 0.46 (Snellen equivalent approximately 20/50; p = 0.02) at 3 months and to 0.40 ± 0.54 (Snellen equivalent approximately 20/50; p = 0.05) at last follow-up. Primary reattachment rate was 85% (17/20) at 3 months and 75% (15/20) at last follow-up visit. CONCLUSIONS: PnR may be an effective treatment option for RRD in pediatric patients meeting PIVOT criteria.

Cost-effectiveness of anti-oxidant vitamins plus zinc treatment to prevent the progression of intermediate age-related macular degeneration. A Singapore perspective.

PURPOSE: To determine if providing high dose anti-oxidant vitamins and zinc treatment age-related eye disease study (AREDS formulation) to patients with intermediate age-related macular degeneration (AMD) aged 40-79 years from Singapore is cost-effective in preventing progression to wet AMD. METHODS: A hypothetical cohort of category 3 and 4 AMD patients from Singapore was followed for 5 calendar years to determine the number of patients who would progress to wet AMD given the following treatment scenarios: (a) AREDS formulation or placebo followed by ranibizumab (as needed) for wet AMD. (b) AREDS formulation or placebo followed by bevacizumab (monthly) for wet AMD. (c) AREDS formulation or placebo followed by aflibercept (VIEW I and II trial treatment regimen). Costs were estimated for the above scenarios from the providers' perspective, and cost-effectiveness was measured by cost per disability-adjusted life year (DALY) averted with a disability weight of 0.22 for wet AMD. The costs were discounted at an annual rate of 3%. RESULTS: Over 5400 patients could be prevented from progressing to wet AMD cumulatively if AREDS formulation were prescribed. AREDS formulation followed by ranibizumab was cost-effective compared to placebo-ranibizumab or placebo-aflibercept combinations (cost per DALY averted: SGD$23,662.3 and SGD$21,138.8, respectively). However, bevacizumab (monthly injections) alone was more cost-effective compared to AREDS formulation followed by bevacizumab. CONCLUSION: Prophylactic treatment with AREDS formulation for intermediate AMD patients followed by ranibizumab or for patients who progressed to wet AMD was found to be cost-effective. These findings have implications for intermediate AMD screening, treatment and healthcare planning in Singapore.