PIVOT outcomes have not changed US surgeons’ preference for pars plana vitrectomy
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Despite the superior visual acuity results and fewer complications of pneumatic retinopexy vs. pars plana vitrectomy shown in the PIVOT study, U.S. practice patterns have not changed, according to a poster at Real World Ophthalmology.
The Pneumatic Retinopexy versus Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomized Trial (PIVOT) was a prospective, randomized controlled trial performed at St. Michael’s Hospital, Toronto. The results, released in 2018 and published in Ophthalmology, showed that pneumatic retinopexy offers superior visual acuity, less vertical metamorphopsia and reduced morbidity when compared with pars plana vitrectomy (PPV) for the repair of rhegmatogenous retinal detachment.
By looking at Medicare data, Serena M. Shah and colleagues found that the publication of PIVOT’s outcomes did not cause a shift toward more pneumatic retinopexy performed by U.S. vitreoretinal surgeons and discussed the possible reasons behind this.
First, “real-world surgical changes take time,” they wrote. While Canadian surgeons are more familiar and experienced with pneumatic retinopexy, PPV has been the gold standard to treat retinal detachment in the U.S.
In addition, the positive benefits of pneumatic retinopexy, such as less metamorphopsia and image displacement, have not been popularized, and surgeons are focused on the potential downsides, such as the long-term persistence of subretinal fluid collections and lower primary reattachment rate. Pneumatic retinopexy also needs more patient cooperation, as a fixed head position must be maintained during recovery. Medicare reimbursement rates, currently $1,181.65 for PPV as compared with $891.57 for pneumatic retinopexy, may also play a role.
A decrease in PPV rates between 2013 and 2021 was attributed by the authors to the COVID-19 pandemic, due to delayed patient presentation for surgical planning due to fear of contracting the disease, and the advantages of scleral buckling in rhegmatogenous retinal detachment.
Reference:
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Shah SM, et al. Pneumatic retinopexy and pars plana vitrectomy usage by United States ophthalmologists before and after publication of PIVOT study. Presented at: Real World Ophthalmology; Sept. 30, 2023 (virtual meeting).
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