Costs and gains of complex procedures to rehabilitate end stage ocular surface disease

Submandibular Gland Transfer for Severe Xerophthalmia

“…Geerling et al 12 argue that although this is a complex and possibly expensive procedure, the improvement in quality of life and the savings for items such as guard dogs more than offset the costs. This involved procedure should not be undertaken lightly, however; the author has used this procedure only as a “last resort,” such as with the SJS patients reported in this series 13 .…”

Transplantation of the Major Salivary Glands

“…It is only indicated in patients with absolute aqueous tear deficiency (Schirmer's test Յ1 mm) with persistent severe pain despite punctal occlusion, a trial of scleral or limbal fit rigid contact lenses, at least half-hourly application of unpreserved tear substitutes and a conjunctivalised corneal surface. For these patients the demand on time and financial resources is however justified not only by significant relief of severe symptoms and some signs of dry eye, but also by substantial gains for society [32,33]. Visual rehabilitation by means of keratoplasty nevertheless remains unsuccessful even after successful SMG transplantation.…”

Cost effectiveness of the type II Boston keratoprosthesis

“…[5][6][7][8] In contrast, several manuscripts have described the modified osteoodontokeratoprosthesis as efficacious in this patient population. [9][10][11] For many, this represents the gold standard for severe ocular surface disease. Nevertheless, the morbidity and postoperative complications associated with this lengthy, two-stage procedure, 11 and the possibility for a more simplistic and pragmatic KPro cannot be ignored, especially as recent modifications to the type II design and postoperative management of patients have led to improved clinical outcomes.…”