RT Journal Article
SR Electronic
T1 Costs and gains of complex procedures to rehabilitate end stage ocular surface disease
JF British Journal of Ophthalmology
JO Br J Ophthalmol
FD BMJ Publishing Group Ltd.
SP 1220
OP 1221
DO 10.1136/bjo.86.11.1220
VO 86
IS 11
A1 G Geerling
A1 C S C Liu
A1 J R O Collin
A1 J K G Dart
YR 2002
UL http://bjo.bmj.com/content/86/11/1220.abstract
AB Background: The management of patients with end stage ocular surface disease sometimes requires extensive surgical treatment that can only be provided by specialised ophthalmology. The authors discuss the costs and gains of such complex techniques based on a case of bilateral corneal blindness secondary to Stevens-Johnson syndrome. Methods and results: Despite multiple lid surgery for trichiasis and repeated corneal grafting for perforations a white female patient became bilaterally blind at the age of 29 years. She also suffered from disabling discomfort in the right dry eye. At the age of 52 a two stage osteo-odonto-keratoprosthesis achieved visual rehabilitation in the left eye and microvascular transplantation of an autologous, submandibular gland resulted in sufficient lubrication to alleviate her severe discomfort in the right eye. As a result of these procedures she was able to take up a regular job again. The total costs of rehabilitation were £13 661 which compare with annual gains and regains for society of £13 497. An additional £4625 was saved annually in guide dog costs. Conclusion: This estimate shows that despite the expense of these complex techniques gains are made well within the second year after rehabilitation. In view of the benefit in quality of life for the patient and monetary savings for society these procedures should be funded by national health services at specialist centres.