Surgical management of corneal limbal dermoids: retrospective study of different techniques and use of Mitomycin C

Treatment of Corneal Dermoid with Fibrin Glue Boned Multi-Layer Lenticules from Small Incision Lenticules Extraction Surgery: A Preliminary Study of Five Patients

PURPOSE

Dermoid excision combined with lamellar keratoplasty was one of the most common surgical techniques for corneal dermoid. Due to the huge shortage of corneal donors, small incision lenticule extraction (SMILE) derived lenticules might be the novel and feasible corneal grafts instead of traditional corneal donors. Therefore, we tried to use FG boned multi-layer lenticules as grafts in the treatment of corneal dermoid.

METHODS

Five patients (the oldest patient was 54 years old and the youngest case was 5 years old) were diagnosed with corneal dermoid and complaining of blurred vision or unsatisfied cosmetic appearance. All patients underwent corneal dermoid excision combined with FG boned multi-layer corneal lenticules transplantation. Slit-lamp microscopy and anterior-segmental optical coherence tomography(AS-OCT)were used to observe ocular appearance, corneal grafts survival, epithelialization, transparency, interlamellar fluid accumulation and the degradation of FG. The preoperative and postoperative change of best-corrected visual acuity (BCVA) and astigmatism were respectively recorded.

RESULTS

All patients were satisfied with the postoperative cosmetic results. BCVA had been increased and astigmatism had been decreased in all cases. We observed that the FG boned multi-layer corneal lenticules were covered with smooth corneal epithelium in one week after transplantation and successfully adhered to the corneal beds, without any dislocation or interlayer separation. FG was gradually degraded and absorbed within 1 month after surgery. The lenticule grafts grew well without rejection and kept transparency during the follow-up period.

CONCLUSIONS

FG boned multi-layer lenticules would be the novel and feasible substitute for lamellar keratoplasty in the treatment of corneal dermoid. FG could not be only used as binder adhering multi-layer lenticules, closing the interlayer space of multi-layer lenticules, preventing the formation of interlayer fluid, but also increasing the thickness and toughness of lenticules, and therefore which is more facilitate to intraoperative suture.

Managing Limbal Dermoids in Patients with Goldenhar Syndrome: A Case Series

Objective

To investigate the clinical characteristics, associated systemic features, and management outcomes of patients with limbal dermoids diagnosed with Goldenhar syndrome.

Methods

This case series included patients from the eye outpatient department, diagnosed with Goldenhar syndrome based on systemic evaluation. Demographic data, ophthalmological assessments, and systemic evaluations were recorded. Various surgical interventions were employed based on the extent of limbal dermoids, and postoperative follow-up spanned one year.

Results

Seven patients (nine eyes) were included, with a mean age of 7.71±4.15 years. Limbal dermoids were bilateral in two patients and unilateral in five. Grade 1 and grade 2 limbal dermoids were observed. The mean BCVA was 0.50±0.11 (logMAR), and astigmatism was present in six patients. Systemic features of Goldenhar syndrome included vertebral anomalies, ear abnormalities, facial anomalies, and lower limb deformity. Surgical interventions varied, with simple excision, lamellar keratoplasty, and amniotic membrane transplantation utilized. Postoperatively, corneal scar formation occurred in all simple excision cases.

Conclusion

This case series underscores the rarity of limbal dermoids in the context of Goldenhar syndrome and the importance of early surgical intervention in managing these cases. By sharing our experiences and outcomes, we hope to contribute to the broader understanding of this condition and its optimal treatment.

A Retrospective Analysis of Corneal Dermoid

BACKGROUND

Corneal dermoid is a congenital benign tumor and ocular malformation, often diagnosed at birth or in early childhood. Its treatment and long-term prognosis remain under-researched, necessitating further investigation.

PURPOSE

This study aims to investigate the epidemiological and clinical characteristics of corneal dermoid, evaluate the efficacy of different surgical methods, and identify factors influencing treatment outcomes.

METHODS

A retrospective analysis was conducted on the clinical data of 58 patients treated for corneal dermoid at our hospital from 2017 to 2021. Patients' demographic information, tumor characteristics, surgical methods, and postoperative outcomes were collected and analyzed. Descriptive statistics, independent sample t-test, chi-square (χ 2) test, and Spearman correlation analysis were used to evaluate the distribution characteristics and intergroup differences of corneal dermoid.

RESULTS

The average age of the patients was 6.3 years, with 55.2% being male and 44.8% female. The right eye was affected in 63.8% of cases, with the temporal limbus being the most common site (75.9%). Pathological examination revealed tumors covered by squamous epithelium, containing hair follicles, sebaceous glands, adipose tissue, and fibrous tissue; some cases also had cartilage and glandular tissue. Surgical methods included corneal dermoid excision (100%), lamellar keratoplasty (37.9%), amniotic membrane grafting (31.0%), and autologous limbal stem cell transplantation (8.6%). None of the 50 followed up patients experienced tumor recurrence. Postoperative vision improved in 58.0% of patients, with more females (61.9%) experiencing visual impairment compared to males (38.1%) (χ²=4.711, p=0.030).

CONCLUSIONS

This study analyzed 58 corneal dermoid patients treated from 2017 to 2021, focusing on epidemiological and clinical characteristics, surgical efficacy, and treatment outcomes. It identified common pathological features and effective surgical methods, with no tumor recurrence in followed up patients. The study highlights the need for further research with larger sample sizes and longer follow-up periods.

Sutureless lamellar keratoplasty with lenticule from small incision lenticule extraction for treating limbal dermoid: A case report

The present study reports the case of a superficial limbal dermoid surgically treated without suture by using a new technique of lamellar keratoplasty with allogenic lenticule from small incision lenticule extraction. The limbal lesion area was circumscribed by a trephine marker and lamellae were peeled off the anterior corneal stroma and sclera. After excision of the dermoid, the liquid on the bed was dried as much as possible and an appropriate stromal lenticule was attached to the implant bed without fibrin glue or suture. A bandage contact lens was applied to fix the graft. During postoperative follow-ups, the anterior segment optical coherence tomography, corneal refractive power, corneal topography and best-corrected visual acuity were examined to evaluate the surgical results. On the first day after the operation, the patient reported tearing and pain at the site. At one week after the operation, the patient reported no discomfort and conjunctival sutures were removed. At one month after the operation, the thickness of the lesion area was similar to that of the adjacent cornea, and the corneal curvature and refractive power of the lesion area were higher than that of the adjacent cornea. At three months after the operation, the patient was satisfied with the cosmetic outcome and no sign of corneal neovascularization, graft rejection or pseudo-pterygium formation was observed. The astigmatic error remained at 2.50 D. The present case provides insights into a potential treatment option for patients who need lamellar keratoplasty and may provide its benefit in contrast to conventional lamellar keratoplasty.

Novel limbal dermoid surgery for visual acuity and cosmesis improvement: A 7-year retrospective review

BACKGROUND

To report a long-term outcome of the novel combined surgical method of complete excision, corneal tattooing, and a sutureless limbal conjunctival autograft for limbal dermoid.

METHODS

All patients who were referred to our clinic for limbal dermoid, and underwent a combined surgery of complete excision, corneal tattooing, and a sutureless limbal conjunctival autograft were retrospectively reviewed. The surgery was performed by one surgeon, and all clinical information was obtained during a seven-year follow up period. In all patients, surgical outcomes of cosmesis, best corrected visual acuity (BCVA), spherical equivalent (SE), and corneal/ocular astigmatism were obtained and compared preoperatively and postoperatively.

RESULTS

During seven years, 24 patients (24 eyes) with limbal dermoid were finally enrolled. The mean age was 10.1±8.9 years old. The surgery resulted in an improved appearing ocular surface in all cases without any complications. There was no statistical difference in BCVA, corneal and ocular astigmatism between preoperatively and postoperatively (p = 0.231, 0.156 and 0.475, respectively). The mean SE was 0.12±3.19D preoperatively, and -0.21±3.02 D postoperatively with statistical significance (p = 0.037). Mean follow up period was 54.50 ± 15.62 months.

CONCLUSIONS

Based on the results of this study, our innovative surgical method which includes complete excision with corneal tattooing and limbal conjunctival autograft can be a simple and safe procedure that achieves long standing cosmesis with limbal dermoids.

Technique for the Management of Extensive Ocular Surface Lipodermoid Involving the Cornea of Children

PURPOSE

Ocular surface lipodermoids with corneal involvement may require surgical intervention; if deep, ocular surface reconstruction with lamellar corneal tissue or amniotic membrane may be needed. We describe a staged technique using autologous ipsilateral simple limbal epithelial transplantation.

METHODS

After verifying sparing of Descemet membrane, the conjunctival portion of the lipodermoid was debulked in the first stage. Six weeks later, the corneal portion was excised, followed by autologous ipsilateral simple limbal epithelial transplantation to promote rapid reepithelialization of the residual stromal bed. Temporary tarsorrhaphy was used for patient comfort and to expedite ocular surface healing.

RESULTS

Three eyes of 3 children with grade III large ocular surface lipodermoids that encroached the visual axis and hindered proper eyelid closure underwent surgery without complications. In all cases, the visual axis was cleared and eyelid closure was improved. At the last follow-up (mean 35.7 months, median 36.0 months), the bed of the original dermoid showed minimal haze in 1 case, while 2 eyes developed small pseudopterygium; best spectacle-corrected visual acuity improved from 20/200 to 20/70 in the first case, from fix and follow to 20/50 in the second case, and remained fix and follow in the last case, but this child had congenital hydrocephalus with severe developmental delay.

CONCLUSIONS

This surgical technique is a promising option for children with grade III large ocular surface lipodermoids given its effectiveness in clearing the visual axis and in improving eyelid closure. Moreover, it does not require lamellar corneal transplantation or intervention to the fellow eye.

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.

Pseudopterygium: An Algorithm Approach Based on the Current Evidence

Pseudopterygium is a non-progressive conjunctival adhesion to the peripheral cornea secondary to a corneal-limbus damage. According to the literature, the main etiology is a previous eye trauma. Nevertheless, this could be biased by the existence of other underdiagnosed causes of pseudopterygium, some of which may have severe consequences for the integrity of the eye and patient’s life. This comprehensive literature review was performed based on a search on the PubMed and Google Scholar databases of relevant pseudopterygium published papers according to our current knowledge and seeks to gather the existing evidence about its diverse etiologies and clinical features, as well as to propose a diagnostic algorithm to simplify its correct approach.

Geometric Profiling of Corneal Limbal Dermoids for the Prediction of Surgical Outcomes

PURPOSE

To search for novel geometric parameters for corneal limbal dermoids that enable the prediction of clinical and surgical outcomes.

METHODS

We reviewed the medical records and anterior segment photographs of 85 eyes of 85 patients with corneal limbal dermoids that had been surgically excised. Patients were assigned to the following 4 cohorts (multiple assignments allowed): postoperative visual acuity (cohort 1, n = 65), amblyopia (cohort 2, n = 67), postoperative scar formation (cohort 3, n = 51), and preoperative spontaneous progression of dermoids (cohort 4, n = 39). For geometric profiling, 11 geometric parameters of lesions, including orientation, angular width, and 9 ratio parameters, were preoperatively defined in each patient based on the digital anterior-segment photographs. Each geometric parameter and demographic variable were analyzed for correlation with postoperative outcomes (cohorts 1-3) and preoperative spontaneous dermoid progression (cohort 4).

RESULTS

The mean patient age at surgery was 6.0 ± 6.3 years. Among the geometric and demographic parameters analyzed, the invaded angular axis of dermoid to corneal diameter ratio had the highest r coefficient (r = 0.728) in cohort 1 and best stratified patients in cohort 2 (cutoff > 0.48) and cohort 3 (cutoff > 0.56). No parameters were correlated with spontaneous dermoid progression in cohort 4.

CONCLUSIONS

We devised geometric parameters to evaluate corneal limbal dermoids before surgery for the prediction of surgical outcomes. The invaded angular axis of dermoid to corneal diameter ratio value was the most significant factor associated with postoperative visual acuity, amblyopia development, and postoperative scarring.

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.].

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.].

Massive corneal-epibulbar dermoid managed with pre-descemetic DALK and SLET

Management of large corneal-epibulbar dermoids always poses a challenge to the surgeons due to deeper corneal involvement. Also, there is a risk of limbal stem cell deficiency and formation of pseudopterygium with larger areas of limbal involvement. We report a novel surgical technique for the management of giant corneal-epibulbar dermoid with pre-descemetic deep anterior lamellar keratoplasty (DALK) and simple limbal epithelial transfer (SLET).

A case of pterygium-like proliferation containing postoperative limbal dermoid remnants: a clinicopathological study

BACKGROUND

This study reports a case of pterygium-like proliferation containing postoperative limbal dermoid remnants and its clinicopathological features.

CASE PRESENTATION

A 79-year-old Japanese woman, with a history of congenital limbal dermoid resection at age 12, presented with a pterygium-like tissue growth in the left eye. Its temporal location and marked thickness with abundant fatty droplets were atypical of primary pterygium. We performed pterygium surgery and ocular surface reconstruction. Pathological findings included squamous metaplasia, neovessels, and elastic degeneration, as well as prominent subepithelial and stromal accumulation of collagen fibers, adipose tissue formation, and presence of a peripheral nerve corresponded with the frequent findings of limbal dermoid. Ki67, a marker for cell proliferation, was immunopositive in pterygial epithelial cells and neovascular endothelial cells, but not in dermoid components.

CONCLUSIONS

Although the pathological finding of degenerative elastic fibers indicated the common feature of ultraviolet-induced pterygium, clinical appearances were atypical possibly due to modification with dermoid remnants.

Surgical management of large bilateral epibulbar dermoids with autologous oral mucous membrane transplantation

Purpose

To report the surgical management of extensive epibulbar dermoids with autologous oral mucous membrane transplantation.

Observations

While rare, extensive dermoids that encroach upon the visual axis carry a poor prognosis. We report the case of a 7-week old premature male infant who presented with large bilateral epibulbar dermoids obscuring the visual axis. He was treated first with sequential bilateral optical iridectomies under the clearest corneal areas, followed several months later by sequential dermoid excision and amniotic membrane transplantation in each eye. He subsequently underwent autologous “simple” oral mucosal epithelial transplantation (SOMET) as well as strabismus surgery. Conclusions and Importance: Here we present the first case, to the best of our knowledge, of the use of SOMET in managing post-operative pseudopterygium following dermoid excision. To our knowledge it is the also the first application of this technique in a young pediatric patient. A good clinical outcome may be achieved with SOMET, which may offer a minimally invasive alternative to other traditional modalities.

Factors predicting long-term changes in refraction after lamellar keratoscleroplasty in children with limbal dermoids

OBJECTIVES

The objective of this study is to determine the factors that predict long-term changes in refraction after lamellar keratoscleroplasty in paediatric patients with limbal dermoids.

METHODS

A retrospective study of 66 children with limbal dermoids who had lamellar keratoscleroplasty correction with more than 1-year follow-up. Univariate and multivariate regression analyses were performed to investigate factors associated with the long term in refractive parameters, including spherical equivalent, astigmatism, and mean keratometry. The change value was defined as the postoperative refractive value minus the preoperative refractive value. The lower the value of changes, the more satisfied the effects on the correction of the preoperative refraction.

RESULTS

A total of 66 patients (mean surgical age: 3.5 ± 2.1 years) were assessed with at least 1-year follow-up. Amblyopia treatment duration was the only independent factor predicting the long-term changes in spherical equivalent between baseline and last follow-up visit (β = -0.030, P < 0.001). Lesion encroachment on the central and paracentral cornea (β = 0.502, P = 0.024), suture-related complications (β = 1.571, P < 0.001) and graft rejection (β = 0.983, P = 0.035) were significantly correlated with long-term changes in astigmatism. The long-term changes in refraction were not correlated with surgical age, lesion size, lesion depth, steroid-induced high intraocular pressure and changes in mean keratometry.

CONCLUSION

Suture-related complications and graft rejection should be carefully observed and appropriately treated in order to avoid the possible postoperative increase in astigmatism, especially for patients with lesion encroachment on the central and paracentral cornea. The long-duration amblyopia treatment after surgery appears to have a better correction effect on spherical equivalent in the long term, compared with astigmatism.

Surgical treatment of corneal dermoid by using intrastromal lenticule obtained from small-incision lenticule extraction

PURPOSE

To report a novel technique to treat superficial limbal dermoid by using the corneal intrastromal lenticules obtained from SMILE and to evaluate the initial clinical outcomes of lenticule patch graft for treatment of limbal dermoid.

METHODS

In this single-center case series, lenticules were obtained from patients undergoing SMILE for the correction of myopia and the lenticule patch graft was performed in three patients with limbal dermoid. Patients were postoperatively followed at first, second weeks and first, third months after surgery. The main measured outcome parameters were included the best-corrected visual acuity, transparency of graft, tectonic integrity and restoration of optical transparency.

RESULTS

All surgeries were successful, and all patients recovered well. Obviously, improving tendency in visual acuity and astigmatism was seen at the final follow-up in all eyes. No statistically significant difference has found in the thickness of the cornea between the surgical field and the corresponding normal field. Globe integrity was achieved in all cases, and no immune rejection or perforation was detected until the last follow-up visit in all eyes treated.

CONCLUSIONS

Lenticule keratoplasty may be a safe, feasible and inexpensive surgical option for the treatment of corneal dermoid. It retains globe integrity and decreases the risk of complications such as postoperative limbal ectasia and visible corneal scarring and should be widely promoted in the areas with shortage of donor corneas.

Giant Ocular Lipodermoid Cyst in Encephalocraniocutaneous Lipomatosis: Surgical Treatment and Genetic Analysis

BACKGROUND Encephalocraniocutaneous lipomatosis is a rare neurocutaneous disorder characterized by cutaneous, ocular, and central nervous system anomalies; its molecular etiology was recently identified. This report describes the surgical treatment and genetic characterization of a giant ocular lipodermoid cyst secondary to encephalocraniocutaneous lipomatosis. CASE REPORT An 11-year-old girl with past medical history of absence seizures presented with a reddish protruding mass in her right eye involving the temporal conjunctiva and the peripheral temporal cornea; eyelid closure was not possible due to mass protrusion. She also presented skin tags at the level of the external canthus and 3 alopecic areas at the level of the scalp compatible with nevus psiloliparus. No family history was reported. A dermoid cyst was suspected and excisional biopsy was performed under general anesthesia. A large conjunctival and lamellar corneoscleral resection was done, followed by a corneal tectonic graft. Molecular analysis was carried out, including PCR and Sanger sequencing on DNA obtained from the mass. After surgery, the patient achieved complete eyelid closure, reduction of ocular surface symptoms, and improved aesthetic appearance. Histological analysis confirmed a lipodermoid cyst; genetic tests confirmed a mosaic activating mutation in FGFR1 (c.1638C>A, p.Asn546Lys). The diagnosis was encephalocraniocutaneous lipomatosis. CONCLUSIONS ECCL is a rare condition; an accurate diagnosis comprising clinical and genetic aspects can facilitate the monitoring of possible complications, improve the multidisciplinary treatment, and provide valuable information for future therapy developments. In this case, the patient's quality of life improved significantly, ocular symptoms disappeared, and a good esthetic appearance was achieved.

Progressive large pediatric corneal limbal dermoid management with tissue glue-assisted monolayer amniotic membrane transplantation: A case report

RATIONALE

Limbal dermoids are choristomas known as congenital benign tumors found in abnormal locations. Despite the benign nature, enlarging limbal dermoids may cause visual abnormalities by cornea infiltration with fat component, visual axis invasion, gradually induced corneal astigmatism, and finally result in anisometropic amblyopia. Here we report a rare case of progressive, large pediatric corneal limbal dermoid in a newborn, managed with tissue glue-assisted monolayer amniotic membrane transplantation.

PATIENT CONCERNS

A 1-day-old male baby (gestational age, 36 ± 6 weeks; birth body weight, 2785 gram) presented to our clinic with a whitish mass on his right eye since birth.

DIAGNOSIS

Ocular examination revealed a solid, whitish-yellow, and ovoid mass with central keratinized epithelium over the superior limbus; the lesion covered two-thirds of the cornea with rapid progression in size. The final pathological examination revealed that the lesion is composed of keratotic lining squamous epithelium resembling epidermis, underling dermal fibrotic connective tissue, and mature fat.

INTERVENTIONS

The patient underwent deep lamellar excision followed by mitomycin C (MMC) soaking (0.2 mg/mL, 3 minutes) and tissue glue-assisted monolayer amniotic membrane transplantation with the ring conformer at 2 months of age.

OUTCOMES

The ring conformer was smoothly removed 2 weeks after the operation. The patient showed a smooth healing process with less pain and rapid corneal re-epithelization. The ocular surface was stable during the follow-up visits, and no complications were detected. Only mild post-operative scarring over the incision wound was observed.

LESSONS

Although a combination of excision, lamellar keratoplasty, and multilayer amniotic membrane and limbal stem cell transplantation is advocated for the treatment of grade II and III pediatric corneal limbal dermoids, the procedure used in this study offers an alternative surgical approach. However, because of the large size of the lesion and the young age of the patient, the management of amblyopia with visual rehabilitation and corneal transplantation is still needed in the future.

Preoperative evaluation and outcome of corneal transplantation for limbal dermoids: a ten-year follow-up study

AIM

To summarize preoperative evaluation and outcome of corneal transplantation for limbal dermoids for ten years.

METHODS

Eighty-five patients diagnosed with limbal dermoids and treated with corneal transplantation were analyzed retrospectively. All patients were further divided into two groups according to absence or presence of neovascularization surrounding the dermoids in the corneal stroma. Eighty-two eyes were treated with tumor excision combined with partial lamellar sclerokeratoplasty, and the other three eyes were performed by penetrating keratoplasty. The size and location of the tumor, the associated ocular and systemic anomalies, the depth of the corneal penetration of tumor tissues, the preoperative and postoperative best-corrected visual acuity (BCVA), graft survival and cosmetic outcome, and surgical complications were recorded respectively.

RESULTS

The average age at surgery was 5.3y (range, 3mo-36y). The mean size of dermoids was 6.1±1.6 mm. The 43.5% of eyes (37/85) were present with hair at the surface of the dermoid and 72.9% of dermoids were located inferotemporal of the eye. Amplyopia was present in 34.1% of patients (29/85) and 9.4% of patients (8/85) had lipodermoids. Eighteen patients suffered from Goldenhar's syndrome with an accessory ear. The 75% of patients in group 1 had involvement of the corneal deep stroma down to Descemet's membrane without involving it, but 71.4% of patients had Descemet's membrane involvement in group 2. Preoperative BCVA ranged from counting fingers to 20/20. Postoperatively 81.1% had a BCVA of 20/800 or better. There was no significant difference between the post-surgical BCVA of the two groups (t=1.584, P>0.05). The grafts of 70.5% patients were present as 1+ opacity, 21.1% as 2+ opacity, 8.2% as 3+ opacity and none as 4+ opacity. Surgical complications included graft rejection, microperforation, prolonged reepithelialization, steroid glaucoma, interface neovascularization, and interface hemorrhage.

CONCLUSION

The dermoids with neovascularization surrounding them in the corneal stroma invaded deeper tissues in the cornea than those with no neovascularization surrounding them in the corneal stroma. Therefore, surgeons should take care to avoid corneal perforation during the corneal transplantation operation. The majority of patients markedly improved their cosmetic appearance after surgery.

Sutureless Lamellar Corneoscleral Patch Graft With Fibrin Sealant for Limbal Dermoid Removal

A 2-year-old boy with Goldenhar syndrome had a limbal dermoid removed and covered with a lamellar corneoscleral patch graft that was attached with fibrin glue and no sutures. The graft healed and attached well. A sutureless technique is beneficial due to decreased scarring and chance of infection.

Shave Excision With Keratopigmentation for Limbal Dermoid

OBJECTIVES

To describe a modified technique of corneal tattooing for concomitant cosmetic rehabilitation in eyes with limbal dermoid.

STUDY

Case series.

METHODS

Three patients between 12 and 20 years of age with grade I limbal dermoid underwent shave excision with corneal tattooing. All patients had dark brown irides. Chemical keratopigmentation was performed over the bed using 2% gold chloride with 1% hydrazine hydrate as reducing agent to yield a dark brown color. Bandage contact lens was applied.

RESULTS

Epithelium over the operated area healed by day 10. Visual acuity was maintained in all eyes with minimal change in keratometry. The dye was well retained in the tattooed area at 1 year. No complications such as infection, pseudopterygium, or local limbal stem-cell deficiency were observed.

CONCLUSION

Corneal tattooing along with simple shave excision provides good cosmetic results in cases of limbal dermoids.