Therapeutic lamellar keratoplasty for limbal dermoids

To assess the surgical outcomes of appearance, vision, refraction, and graft survival and integrity in patients with histologically proven limbal dermoid choristomata who underwent lamellar keratoplasty.

Retrospective noncomparative analysis of a consecutive case series with patient recall and examination.

Eleven patients (six female, five male, median age, 9.6 years; range, 1-29 years) with 12 limbal dermoids in 11 eyes operated on between 1995 and 1998 were identified from the eye bank database at the Singapore National Eye Centre.

Case records, photographs, and eye bank data were examined. Patients not already seen by the authors within the previous 3 months were recalled and examined.

Descriptive data: size and location of the dermoid, presence of lipid keratopathy; visual acuity; refraction and astigmatism, vector analysis, surgically induced refractive change; corneoscleral and limbal match, haze, vascularity; graft integrity, clarity, vascularization, and rejection episodes.

Most (7 of 11) patients had single inferotemporal limbal dermoids, although one patient had two dermoids in one eye. Median follow-up time was 21.6 months (range, 9.0-46.4 months). Most (8 of 11) patients had good or excellent cosmetic results with minimal interface haze and no vascularization. Two cases with previously excised lesions had postoperative vascularization develop. One of these cases had graft infection develop, underwent subsequent debridement, and has an opaque graft. Best-corrected visual acuity was maintained or slightly improved in 9 of 11 patients. For the group and most individual patients, mean astigmatism, spherical equivalent, and refraction, as assessed by surgically induced refractive change and h-vector analysis, were not significantly changed.

Lamellar keratoplasty as primary surgery for limbal dermoids gave good cosmetic results. However, improvement in refractive, astigmatic, and visual status is not guaranteed, and these procedures should be viewed more cautiously, although established good vision was maintained in our series.