Combined Multilayered Amniotic Membrane Graft and Fibrin Glue as a Surgical Management of Limbal Dermoid Cyst

Abstract

Background/Objectives: To report the cosmetic, clinical, and visual outcomes of a combined surgical approach for treating a corneal/limbal dermoid using excision and a three-layered amniotic membrane graft with fibrin glue. Methods: An 18-year-old female presented with impaired vision and ocular discomfort caused by a prominent dome-shaped limbal congenital dermoid on the inferotemporal cornea, resulting in a significant aesthetic concern. A full assessment, including refraction, best-corrected visual acuity (BCVA), corneal topography, aberrometry and anterior segment OCT (AS-OCT) was conducted to plan the surgical approach. The dermoid was excised under peribulbar anaesthesia using manual lamellar dissection, followed by the application of 0.02% Mitomycin C and a multilayered amniotic membrane graft with fibrin glue. A bandage contact lens was applied and removed after three weeks, with postoperative treatment including topical antibiotics and steroids. Follow-ups were conducted on day 1, at 1 week, 3 weeks, 2 months, 6 months, 1 year, and 2 years. Results: Histopathological examination confirmed the mesoblastic nature of the lesion. Significant improvements in BCVA and ocular symptoms were observed. Corneal topography showed ocular surface regularization with reduction of high order aberrations and point spread function. AS-OCT showed complete integration of the amniotic membrane, with full epithelial coverage of the defect. The healing process was uneventful and the ocular surface remained stable throughout the entire follow-up, without complications or recurrence. Conclusions: This approach of dermoid excision, multilayered amniotic membrane and fibrin glue restored vision effectively, with notable improvements in ocular surface and cosmetic outcomes, without recurrence over two years.

Keywords: amniotic membrane; corneal dermoid; fibrin glue; mitomycin C.

Figure 1

Preoperative slit lamp photograph of inferotemporal limbal dermoid (A). Sirius topography image of anterior tangential curvature revealing a significant irregularity of the ocular surface (B). Aberrometric assessments showing Point Spread Function (PSF) with Strehl Ratio (C) and whole corneal aberrations (D,F). Heidelberg Spectralis anterior segment optical coherence tomography (AS − OCT cornea module) scan showing the hyperreflective lesion without a clear evidence of its depth (E).

Figure 2

1 week postoperative slit lamp image showing the multilayered amniotic membranes graft perfectly covering the defect after the dermoid removal (A). Sirius topography images revealing a significant improvement in the regularity of the ocular surface (B). Aberrometric assessment with a substantial reduction in total corneal aberrations including both LOAs and HOAs, along with a notable improvement in PSF and Strehl ratio (C,D,F). Heidelberg Spectralis OCT images demonstrating a complete integration (graft) of the three-layered amniotic membrane into the corneoscleral surface (E).

Figure 3

Slit lamp images taken two years post-surgery showing no signs of recurrence (A,B), proper corneal thickness (C), and no evidence of neovascularization or significant scarring (A,B). The epithelial map (D) and OCT scans (E) show a compensatory epithelial thickening in the inferotemporal cornea (between 63 µm and 68 µm).