Ophthalmic features and management outcomes of 30 children having Goldenhar syndrome

Visual and surgical outcomes of limbal dermoid excision at a tertiary care eye hospital

PURPOSE

To evaluate the presenting complaints, surgical management, surgical outcomes, complications, and postoperative visual acuity following limbal dermoid excision.

DESIGN

Retrospective cohort study.

METHODS

Medical records of patients with limbal dermoid presenting between January 2012 and December 2020 were retrieved to extract data regarding demographics, presenting profiles including the best-corrected visual acuity (BCVA), symptoms, anterior segment examination, and refraction. The outcomes included cosmesis, complications, graft transparency, and BCVA at the last follow-up.

RESULTS

Fifty-one eyes from 50 patients (27 males) were evaluated. The median age at the time of surgery was 11.5 years (interquartile range, IQR: 0.0-45.7). The median follow-up time was 5 years (IQR: 4-6). Goldenhar syndrome was noted in 5 patients (10%). The indications for surgery were cosmetic concerns (n  =  20, 39%), anisometropia (n  =  3, 6%), decreased vision (n  =  4, 8%), and growth or Dellen formation (n  =  2, 4%). Forty-eight were operated upon, opting for simple excision (n  =  12, 23.5%), amniotic membrane transplantation (n  =  16, 31.4%), lamellar keratoplasty (n  =  15, 29.4%), and penetrating keratoplasty (n  =  5, 9.8%). The most common complications were corneal scarring (n  =  19, 37.2%), corneal vascularization (n  =  2, 3.9%), and infection (n  =  1, 2%). Astigmatism > 1 D was observed in 34 (66.7%) eyes after dermoid management (p < 0.001). There were no complications in 14 eyes (27%), BCVA was > 20/60 in 43 eyes (84.3%), and only two eyes had BCVA < 20/400.

CONCLUSION

Surgical management of limbal dermoids offers promising functional and anatomic outcomes. However, postoperative astigmatism may require further follow-up and management.

Clinicopathological characteristics of ocular surface squamous neoplasia: a 10-year review form a referral tertiary centre in Nigeria

BACKGROUND

Ocular surface squamous neoplasia (OSSN) is a heterogeneous group of proliferative squamous lesions on the ocular surface with varying biologic behaviours. This study aims to report the clinical profile and pathological characteristics of cases of OSSN seen at a tertiary referral centre in North West Nigeria.

METHODS

A retrospective review of all cases of OSSN diagnosed over a 10-year period was done.

RESULTS

OSSN accounted for 68 out of 91 ocular surface lesions affecting twice as many males as females and a peak incidence in the 30-39 years age group. They frequently presented as higher-grade and higher-stage lesions with invasive squamous cell carcinoma being the most frequently diagnosed OSSN. They also frequently showed an association with HIV infection and a relatively long duration of symptoms before presentation.

CONCLUSION

OSSN occurs in a relatively young age group in our environment. Certain clinical and epidemiological features appear to predict the occurrence of higher-grade lesions, and this may help in the clinical prediction of likely pathologic grade and/or biologic behaviour of these lesions.

A decade of clinical research on clinical characteristics, medical treatments, and surgical treatments for individuals with craniofacial microsomia: What have we learned?

AIM

This article provides a review of a decade of clinical research studies on clinical features, medical interventions, and surgical interventions for individuals with craniofacial microsomia (CFM). We also provide recommendations for future clinical research.

METHOD

A systematic search of literature was conducted in Embase and PubMed/MEDLINE Ovid. All publications from 2010 to 2020 that included at least 10 individuals with CFM were considered relevant for this study.

RESULTS

A total of 91 articles were included. In the past decade, many new studies on CFM have been published providing more insight on the diagnosis and management of patients with CFM. This review encompasses findings on the clinical difficulties patients with CFM encounter, including the craniofacial and extracraniofacial characteristics of patients with CFM and its related clinical consequences on breathing, feeding, speech, and hearing.

CONCLUSIONS

A considerable number of large multicenter studies have been published in recent years, providing new insights in the clinical consequences of CFM. The phenotypic variety between patients with CFM makes patient-specific treatment tailored to individual needs essential. The research and development of clinical care standards might be challenging because of the heterogeneity of CFM. Future research on clinical and patient-reported outcomes can help identify optimal treatment strategies. Cooperation between craniofacial centers, using uniform registration and outcome measurement tools, could enhance research and future care for these patients.

LEVEL OF EVIDENCE

Level IV.

Bilateral Limbal Dermoid as an Isolated Finding in a Child

The authors report a case of a bilateral limbal dermoid in a 4-year-old girl with no extraocular anomalies or systemic associations. The child's best corrected visual acuity was 20/50 in the right eye and 20/40 in the left eye. There was a small limbal dermoid located on the inferotemporal side in the right eye and a large elevated limbal lesion that extended over the visual axis in the left eye. Limbal dermoid excision and lamellar keratoplasty were performed in the left eye and followed by a simple excision of the limbal dermoid in the right eye. Histopathological examination confirmed the clinical diagnosis of a dermoid. At the 2-year follow-up visit, the child's best corrected visual acuity had improved to 20/30 in both eyes. Tumors of the corneal limbus are extremely rare. Simple excision is a viable method of treatment for smaller, superficial lesions, although larger lesions can obstruct the visual axis and produce irregular astigmatism and amblyopia. In this patient, surgical intervention resulted in a reasonable cosmetic and final visual outcome. [J Pediatr Ophthalmol Strabismus. 2021;58(4):e27-e29.].

Bilateral Epibulbar Dermolipomas in a Patient With Goldenhar Syndrome

ABSTRACT

A 19-year-old woman consulted for bilateral superotemporal conjunctival lesions that had been present since birth. Physical examination also revealed hemifacial microsomia and bilateral auricular appendages. Medical history included heart, hearing, and neurologic problems. Excision biopsy of these lesions showed nodular proliferations of adipose tissue, which corresponded to the diagnosis of dermolipomas in the setting of Goldenhar syndrome. Complete examination for other first and second branchial arch anomalies is warranted in patients presenting with such lesions.

Management of Limbal Dermoids by Simple Excision in Young Children

PURPOSE

To report the visual outcomes, refractive results, and complications of simple excision for limbal dermoid in the first 8 years of life.

METHODS

This retrospective chart review included all children aged 8 years or younger who underwent excision of a grade I or II limbal dermoid without involvement of the visual axis between the years 2000 and 2019.

RESULTS

Nineteen patients met the inclusion criteria. Their mean age was 4.2 ± 2.0 years (age range: 9 months to 8 years). The mean change in visual acuity was +1 ± 2.3 lines. The mean astigmatism was 3.20 ± 1.80 diopters (D) preoperatively and 3.50 ± 2.20 D at the last visit; the mean change in the astigmatism power was +0.20 ± 1.20 D (range: -1.50 to +2.75 D). Epithelial healing occurred in a mean of 8 days. No complications such as perforation were encountered. All patients had a good cosmetic outcome.

CONCLUSIONS

Reepithelialization led to good cosmetic outcomes after this quick, simple, and uncomplicated procedure. There was no significant change in visual acuity or astigmatism, so amblyopia and astigmatism reduction are poor indications for limbal dermoid excision. Families should be counseled preoperatively that correction of the astigmatism and patching will remain essential in the postoperative management of amblyopia. [J Pediatr Ophthalmol Strabismus. 2021;58(3):196-201.].