A cost minimisation analysis comparing iStent accompanying cataract surgery and selective laser trabeculoplasty versus topical glaucoma medications in a public healthcare setting in New Zealand.

PURPOSE: To produce an economic comparison of the iStent ab interno trabecular microbypass implant accompanying cataract surgery and selective laser trabeculoplasty (SLT) as first-line treatment versus topical medications for open-angle glaucoma in New Zealand in 2016. METHODS: The current annual costs of 19 available fully subsidised topical glaucoma medications by Pharmaceutical Management Agency (Pharmac) in 2016 were identified. Adjustments for pharmacist prescribing charges and previously described wastage levels were applied. The costs to perform iStent implantation and the cost to perform SLT were obtained from the local distributors, with the latter taking into account staff and consumable cost. Procedure costs divided by eye drops' cost produced a break-even level in equivalent years of eye drops use. RESULTS: The range of annual eye drop cost was NZD$42.25 to NZD$485.11, with an average of NZD$144.81. Comparison of annual eye drop cost with iStent cost revealed 3 of 19 (15.8%) drops breaking even within 5 years, 9 of 19 (47.3%) within 10 years, and 12 of 19 (63.2%) within 15 years. The cost of bilateral SLT performed by a consultant was NZD$102.30 (breaking even in 0.71 years). The equivalent cost for a registrar was NZD$97.59 (breaking even in 0.67 years). CONCLUSION: Economically, the iStent would appear to be a reasonably cost-effective treatment for glaucoma patients undergoing cataract surgery in a public healthcare setting in New Zealand, particularly for those using more expensive topical glaucoma medications, whilst SLT appears to be a worthwhile consideration as a first-line treatment for glaucoma in New Zealand.

Measuring phacoemulsification groove depth using probe tip dimensions and biometry lens thickness readings.

AIM: To describe a useful technique utilizing lens thickness from biometric data as well as phacoemulsification (phaco) probe tip dimensions, in order to more accurately determine safe groove depth during divide and conquer techniques for cataract surgery. METHODS: Single center, selection of patients for cataract surgery deemed low risk and suitable for surgical teaching cases. Individual lens thickness measurements from biometry were calculated with known phaco tip dimensions to give an individualized safe number of phaco tip depths for grooving during divide and conquer. This technique was then applied during cataract surgery. RESULTS: Utilization of this technique allows calculation and determination of an appropriate number of phaco tip depths of grooving for each individual patient. This technique was applied as a teaching tool for surgical trainees, with subsequent successful safe cataract surgeries completed. No posterior capsule ruptures were noted for these cases. CONCLUSION: By combining the biometric measurements of an individual patient's lens thickness together with known phaco tip dimensions, individualized safe groove depths can be theoretically determined and applied during divide and conquer cataract surgery.

Cystoid macular edema associated with acitretin.

Cystoid macular edema represents a "final common pathway" response of the retina to a variety of insults. It has been reported in association with vascular problems, inflammatory conditions, inherited diseases, tractional problems, intraocular surgery and medications. We report a case of cystoid macular edema associated with acitretin in a 65-year-old woman and document its resolution with optical coherence tomography (OCT).

Do Optic Disc Drusen Cause Unilateral Nyctalopia?

This is a case report of a patient with unilateral nyctalopia in whom ipsilateral optic disc drusen were the only finding despite extensive investigation.

Patients prefer once-daily glaucoma drops.

BACKGROUND: The relationship between complexity of eye drop regime and compliance is not straightforward, i.e. fewer drops may not mean better compliance. We investigated the level of inconvenience different eye drop regimes incurred in comparison with a once-daily (OD) regime for patients experienced with using topical anti-glaucoma medication. METHODS: Patients indicated the level of inconvenience from drop regimes of 1, 2, 3 or 4 times daily on 10-cm visual analogue scales. The score for the OD regime was then compared with the scores for the other regimes using paired t-tests with Bonferroni correction. RESULTS: At a significance limit of p = 0.05, five of six subgroups indicated once-a-day drops were significantly more convenient than other regimes. Patients who had used the OD regime considered this difference greater than those who had not. CONCLUSIONS: This study's results offer some pragmatic guidance on choice of therapy and on counselling patients about compliance. We would suggest starting patients on OD drops in preference to alternatives to promote compliance.

Better optic disc examination: wearing loupes enhances the indirect ophthalmoscope image.

Optic disc examination with the indirect ophthalmoscope is frequently used in the assessment of pediatric glaucoma cases. If the usual viewing eye-pieces are removed from the headgear and loupes worn instead, then a greatly magnified view of the disc is seen with little change to technique or ease of examination.

An indeterminate malignant soft-tissue tumour treated by exenteration.

PURPOSE. To present a case of malignant soft-tissue tumour, which has yet to be categorised despite review by an international panel of experts, and which was treated by exenteration. PATIENT & METHODS. A 15-year-old Caucasian girl presented with progressive, non-axial proptosis and diplopia. CT scan showed an extraconal mass in the supero-medial part of the orbit suggestive of a vascular neoplasm. After initial incisional biopsy, the pathology of the tumour was felt to be malignant but so unique that further tissue was required for classification/categorisation and that exenteration was the best way to proceed. RESULTS. Despite there being an adequate amount of tissue and opinions being sought from international experts, including the Children(1)s Soft Tissue Panel (of the United Kingdom), this tumour has yet to be categorised. Reports have suggested it to be anything from a malignant desmoplastic round-cell tumour or a synovial sarcoma to an epithelioid haemangioendothelioma, which is our current working diagnosis. CONCLUSION. This case is unique in that it has not been possible to classify the tumour. Categorisation is important in order to give a reasonably accurate prognosis to the patient. Exenteration was required to offer complete tumour excision and will hopefully prevent local recurrence and metastatic spread.