title: Costs and gains of complex procedures to rehabilitate end stage ocular surface disease.
abstract: 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.
  
  
  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 pound 13 661 which compare with annual gains and regains for society of pound 13 497. An additional pound 4625 was saved annually in guide dog costs.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Medizinische Universität Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany. ggeerling@aphthamu-luebeck.de
authors.forename: G
authors.initials: G
authors.lastname: Geerling
authors.forename: C S C
authors.initials: CS
authors.lastname: Liu
authors.forename: J R O
authors.initials: JR
authors.lastname: Collin
authors.forename: J K G
authors.initials: JK
authors.lastname: Dart
mesh_terms: D000328:Adult; D003365:Costs and Cost Analysis; D015352:Dry Eye Syndromes / Q000191:economics / Q000534:rehabilitation / Q000601:surgery; D005128:Eye Diseases / Q000191:economics / Q000534:rehabilitation* / Q000601:surgery; D005260:Female; D006801:Humans; D013508:Ophthalmologic Surgical Procedures / Q000191:economics / Q000379:methods; D013262:Stevens-Johnson Syndrome / Q000150:complications*; D013363:Submandibular Gland / Q000637:transplantation