Treatment of corneal dermoid with lenticules from small incision lenticule extraction surgery: a surgery assisted by fibrin glue

Abstract

Aim: To observe the clinical efficacy of the combined use of small incision lenticule extraction (SMILE)-derived lenticule patches in corneal dermoid excision, with fixation of the lenticule patches assisted by fibrin glue.

Methods: Seventeen eyes of 17 patients with corneal dermoid were treated with dermoid removal combined with SMILE-derived lenticule transplantation. All lenticule patches were fixed by fibrin glue. Ocular changes were assessed using slit lamp microscopy and anterior-segmental optical coherence tomography. The best-corrected visual acuity (BCVA) and ocular dioptric variations were examined preoperatively and postoperatively. Intraocular pressure (IOP) was also monitored in all visited time.

Results: Totally, 18 lenticule patches were used on 17 eyes of 17 cornea dermoid patients. The mean follow-up time was 11.47±5.28mo. All lenticule patches were successfully glued, kept on its location and maintained transparent during the follow-up time, with a consecutive epithelial cover for 1wk. Nine of the patients could coordinate visual and optometry exam well. Their preoperative BCVA is 0.60±0.35 in decimal, significantly improved to 0.80±0.26 in decimal at 6mo postoperatively (Z=-2.392, P=0.017), but the changes of their corneal astigmatism diopters showed no significance, with 2.22±1.91 D preoperatively, and 2.28±1.31 D at 6mo postoperatively (Z=-0.135, P=0.893). Limbal pannus formation occurred in 4 (23.52%) cases and decreased with the application of tacrolimus eyedrops. IOP increased in 2 (11.76%) cases, but well decreased by timolol maleate eyedrops. All the adult patients or guardians of minor patients were satisfied with the cosmetic improvement.

Conclusion: Dermoid excision combined with transplantation of SMILE-derived lenticule patches using fibrin glue is a safe and effective novel tectonic keratoplasty procedure for corneal dermoid.

Keywords: corneal dermoid; fibrin glue; small incision lenticule extraction.

Figure 1. Case 2 treated with lenticules from SMILE

A: The corneal dermoid was 5.5×5.5 mm² with BCVA was 0.1 (decimal) preoperative; B: Postoperative 2wk, the dermoid was removed completely and the SMILE-derived lenticule was imbed well with the BCVA was 0.3 (decimal); C: Postoperative 4mo, mild vasodilation in the temporal conjunctiva, the BCVA was 0.4 (decimal); D: Postoperative 8mo, the temporal conjunctival vasodilation regressive with the BCVA was 0.6 (decimal). SMILE: Small incision lenticule extraction; BCVA: Best corrected visual acuity.

Figure 2. Case 5 treated with lenticules from SMILE combined with AM

A: Primary corneal dermoid was 7.5×7.5 mm² with BCVA was 0.3 (decimal) preoperative; B: Postoperative 1mo, conjunctival suture was removed with vasodilation at the limbus, and the lenticule was imbed well with the BCVA was 0.8 (decimal); C: Postoperative 6mo, the vasodilation regressive with the BCVA was 0.8 (decimal); D: Postoperative 10mo, the BCVA was 0.9 (decimal), but the corneal opacity existed. BCVA: Best corrected visual acuity; SMILE: Small incision lenticule extraction; AM: Amniotic membrane.

Figure 3. Anterior segment optical coherence tomography of case 2

A: A dermoid change was seen in temporal limbus, crossing the cornea and conjunctiva preoperative; B: Postoperative 2wk, the dermoid was removed completely and lenticule graft was imbed well with smooth and consecutive corneal epithelium; C: Postoperative 4mo, the lenticule graft was well fused with recipient corneal tissue; D: Postoperative 8mo, the lenticule graft remained stable.

Figure 4. Anterior segment optical coherence tomography of case 5

A: A dermoid change was seen in the inferior cornea and limbus preoperative; B: Postoperative 1mo, the lenticule graft was imbed well with smooth and consecutive corneal epithelium; C: Postoperative 6mo, the lenticule graft grew well on its position; D: Postoperative 10mo, the lenticule graft remained stable.

Figure 5. Anterior segment optical coherence tomography of case 1

A: Preoperative; B: Postoperative 1wk, corneal epithelium was smooth and consecutive with a interspace (white arrow) in the central corneal graft while the peripheral area was tightly adhered; C: Postoperative 2wk, the interspace disappeared; D: Postoperative 3mo, the lenticule graft grew well, and fused with the recipient corneal stromal layer partially; E, F: Postoperative 6 and 9mo, the lenticule graft grew and structured with recipient cornea well.