Management of pediatric corneal limbal dermoids

Abstract

This paper reviews the data in the published literature (PubMed from 1937 to 2011) concerning the medical and surgical management of pediatric limbal dermoids. Current standard medical treatment for grade I pediatric limbal dermoids (ie, with superficial corneal involvment) is initially conservative. In stages II (ie, affecting the full thickness of the cornea with/without endothelial involvement) and III (ie, involvement of entire cornea and anterior chamber), a combination of excision, lamellar keratoplasty, and amniotic membrane and limbal stem cell tranplantation are advocated. Combinations of these approaches seem to yield better and more stable long-term ocular surface cosmesis and fewer complications in comparison with traditional methods of excision and lamellar keratoplasty. Management of amblyopia (i.e. occlusion treatment, chemical penalization with/without spectacle wear, etc) must continue after surgical excision to yield optimal results when or if the surgery is done at a younger age.

Keywords: amniotic membrane; limbal dermoid; surgical management; tissue adhesive.

Figure 1

Grade 1 limbal dermoid.

Figure 2

Grade II limbal dermoids involving nearly the entire depth of cornea up to Descemet’s membrane.

Figure 3

Grade III dermoid with staphyloma.

Figure 4

Histological cross-section of ocular dermoid.