Cost-effectiveness in eyebanking.

The current operating budget for American eyebanks is more than $5 million per year, and an increasing portion of this expense is being paid by third-party payers. American eyebanks were surveyed to determine what a reasonable cost per transplant tissue might be and to see if recommendations could be made that would help optimize cost-effectiveness in American eyebanking. Most well-run eyebanks needed between $222 to $464 to process each donor cornea for transplantation. This cost-effective goal was most often met if the bank provided at least 150 corneas annually and if there was a full-time professional staff using modern tissue preservation techniques. An eyebank unable to meet these goals should consider obtaining its tissue from the nearest cost-effective eyebank, allowing the redirection of charitable contributions to other more cost-effective eye care-related community activities.

Extended wear hydrogel lenses. Long-term effectiveness and costs.

During the period 1976-79, 1,201 of 1,552 aphakic patients were successfully fitted with third generation extended wear hydrogen lenses of thin-membrane design (CSI¿ lens) and highly hydrated polymer design (Permalens,¿Sauflon¿) without significant or permanent visula loss. Between 79% and 82% of the patients who failed did so in the first 90 days, and thereafter failure rates declined with time. Replacement rates for lenses approximated one lens per eye per year. Rates of required removal for cleaning varied. Ten to 13% of patients required cleaning at less than three-month intervals, and 5-6% at less than one month. For average patients with unilateral devices and no complication, extended wear lenses in Georgia are estimated to cost approximately three times as much as an intraocular lens over a 20-year follow-up period. General advantages ofextended wear third generation lenses include: (1) an acceptably savce and visually effective way to correct aphakia when patients are carefully selected, fitted, educated, and followed; (2) can be easily removeed, refitted or updated as technology advances; and (3) will not replace intraocular lenses, but can be used when implantation is contraindicated and should prevent the need for secondary or bilateral implantation or keratophakia in most cases.

Primary radiation therapy for meibomian gland carcinoma.

Three patients with Meibomian gland carcinoma were treated initially with irradiation. This therapy was palliative in one case that eventually required orbital exenteration because of recurrent disease. A second patient was clinically tumor-free ten months after treatment when he died of a myocardial infarction. The third patient has shown no evidence of recurrent disease in the 25 months since treatment.