Surgical reduction of ocular pigmentation in patients with oculodermal melanocytosis

Utility of anterior segment optical coherence tomography in the surgical planning of superficial sclerectomy in oculodermal melanocytosis (nevus of Ota): A case report and review of literature

Purpose

to report the utility of Anterior Segment Optical Coherence Tomography (AS OCT) for planning superficial sclerectomy in a patient with nevus of Ota.

Observations

Oculodermal melanocytosis, also called nevus of Ota, is a benign pigmentary disorder that involves the skin innervated by the first and second branches of the trigeminal nerve. To reduce these black or brownish lesions, different surgical treatments have been reported, such as flipped scleral flap, sclera allograft and the grabbing method. Superficial sclerectomy is a recent technique that has proven effective in improving scleral pigmentation. Although this procedure allows the operating time to be reduced and results in a smoother scleral bed surface, it has a limitation, represented by the difficulty of estimating the depth of the sclerectomy: an inaccurate estimate or incorrect depth could cause an inadequate deep scleral dissection with excessive weakening of the sclera. We report a case of a 27-year-old patient with nevus of Ota undergoing superficial sclerectomy. The depth of scleral pigmentation was evaluated with AS OCT images before the surgery, allowing a superficial sclerectomy to be performed with a precalibrated diamond blade.

Conclusions and Importance

In oculodermal melanocytosis (nevus of Ota) the use of AS OCT images showing the depth of scleral pigmentation could lead to the most effective and safest surgical choice for each case.

Pigmentary disorders of the eyes and skin

Oculocutaneous albinism, Menkes syndrome, tuberous sclerosis, neurofibromatosis type 1, dyskeratosis congenita, lentiginosis profusa syndrome, incontinentia pigmenti, and Waardenburg syndrome all are genodermatoses that have well established gene mutations affecting multiple biological pathways, including melanin synthesis, copper transport, cellular proliferation, telomerase function, apoptosis, and melanocyte biology. Onchocerciasis results from a systemic inflammatory response to a nematode infection. Hypomelanosis of Ito is caused by chromosomal mosaicism, which underlies its phenotypic heterogeneity. Incomplete migration of melanocytes to the epidermis and other organs is the underlying feature of nevus of Ota. Vogt-Koyangi-Harada and vitiligo have an autoimmune etiology; the former is associated with considerable multiorgan involvement, while the latter is predominantly skin-limited.

Efficacy and safety of combination treatment for oculodermal melanocytosis: surgical reduction and use of 532-nm Q-switched Nd: YAG laser

PURPOSE

The aim of this study was to evaluate the efficacy and safety of combination treatment using surgical reduction technique and 532-nm Q-switched Nd:YAG laser treatment for the removal of oculodermal melanocytosis.

METHODS

We retrospectively reviewed the medical records of patients who underwent combination treatment using surgical reduction and 532-nm Q-switched Nd:YAG laser for the removal of ocular pigmentation in oculodermal melanocytosis at Asan Medical Center (Seoul, Korea) between January 2009 and January 2013. The safety and cosmetic efficacy of this new surgical strategy were assessed by both patients and observers.

RESULTS

Fifty eyes of 47 patients with oculodermal melanocytosis were enrolled. Ocular pigmentation was successfully reduced in all patients, and all patients were satisfied with the cosmetic results at the last visit. Preoperative and postoperative corrected visual acuity, keratometry, and refractive errors did not significantly differ. Postoperative intraocular pressure was significantly reduced (mean change, 2.33 ± 3.54 mm Hg; P = 0.03) at 1 month after surgery. During the follow-up period, no serious adverse events developed other than conjunctival neovascularization and conjunctival inclusion cyst in 5 eyes, respectively.

CONCLUSIONS

Combination treatment for oculodermal melanocytosis removal seems to be cosmetically satisfactory and safe. This study suggested that combination treatment using surgical technique and 532-nm Q-switched Nd:YAG laser may be helpful for the removal of oculodermal melanocytosis.