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

Abstract

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.

Fig 1. The surgical procedure for complete excision, corneal tattooing, and sutureless conjunctival limbal autograft (Case #3).

The limbal dermoid is visualized inferiorly (*) (A); The corneal portion of the dermoid is excised with a residual stromal opacity(*) (B); The opacity is tattooed through anterior stromal puncture (C); The conjunctival portion of the dermoid is excised (D); A superior conjunctival limbal graft was harvested(*) (E); The graft is adhered over the conjunctival defect with fibrin glue(*) (F).

Fig 2. Pre- and post-operative external photographs and high magnification slit lamp photographs of limbal dermoid patients.

A: Case #5. A 5-year-old female with a inferotemporal limbal dermoid. B: Case #8. An 11-year-old female with a inferotemporal limbal dermoid. C: Case #9. A 22-year-old female with a temporal limbal dermoid with vascularization. D: Case #13. A 3-year-old female with a inferotemporal limbal dermoid. E: Case #18. A 3-year-old male with a superotemporal limbal dermoid. F: Case #19. A 3-year-old male with a inferotemporal limbal dermoid. G: Case #20. A 31-year-old female with a inferotemporal limbal dermoid. All the postoperative photos were taken 3 years after surgery.

Fig 3. Serial changes of anterior segment photography of case #8.

The inferotemporal limbal dermoid is seen(A), and on postoperative day 1, grafted conjunctiva is clearly seen(B). After 3 weeks, no injection or resolution of subconjunctival hemorrhage was observed. The grafted conjunctival margin was faintly visible (C). No conjunctival neovascularization or pseudo-pterygium was found, indicating good cosmetic results. postoperative 3 years(D).

Fig 4. Postoperative photos of a simple inferotemporal dermoid excision.

In this photo, we can see prominent corneal opacity(*) and conjunctivalization(white *) with many vessels of adjacent conjunctiva which makes the eye look injected. The surgery was done at the other hospital.

Fig 5. Refractive changes after surgery for limbal dermoid.

Asteroid refers to statistical significance (p<0.05). (K astig: corneal astigmatism by auto keratometry, O astig: ocular astigmatism by manifest refraction test, SE: spherical equivalent).