Outcome of lamellar keratoplasty for limbal dermoids in children

We report on the surgical management, complications, postoperative visual acuity, and astigmatism of limbal dermoids in children.

This was a retrospective study of 49 children (51 eyes) treated between 1990 and 2000. Demographic data, age at surgery, details of the surgical procedure, the preoperative and postoperative visual acuity and astigmatism, the complications of surgery, and the ocular and systemic associations were recorded. Age at surgery was regressed against the size of the corneal graft, the visual outcome, and astigmatism. The size of the corneal graft was regressed against the visual outcome and astigmatism. A test for a difference in proportions of the preoperative and postoperative astigmatism was conducted. Postoperatively children were followed up until suture removal if necessary at 4 weeks. Children living locally continued follow-up at The Hospital for Sick Children, Toronto, Ontario, Canada; the rest were referred to their referring ophthalmologist.

The mean age of the patients at surgery was 4.4 +/- 3.8 years (range, 1 month to 15 years). Excision of the dermoid and lamellar keratoplasty was performed in 48 eyes, simple excision was performed in 2 eyes, and a penetrating graft was performed in 1 eye. The mean graft size (6.6 +/- 1.2 mm; range, 3.5-10 mm) was inversely related to the age of the patient (P =.04). Three eyes had microperforations during excision of the dermoid. Opacification of part of the graft was seen in 10.2% of eyes (5/49) with a mild haze in 3 eyes. Postoperatively 96.7% of eyes (29/30) had a visual acuity greater than or equal to 6/24, with 86.7% (26/30) greater than or equal to 6/12; one eye had a visual acuity of 6/120. The size of the graft correlated inversely with the visual acuity (P =.03). Preoperative and postoperative refraction was recorded in 23 patients. Astigmatism greater than 1 D was present in 43.4% preoperatively and in 60% postoperatively (P =.6). There was no association between age at surgery (P =.6) and the size of the graft (P =.2) and the presence of postoperative astigmatism.

Excellent visual results were achieved in the majority of patients. Younger children were operated on for visual reasons with larger grafts and a tendency for a lower visual acuity. Although astigmatism was noted to decrease in a few children after excision, a significant number had an increase in astigmatism postoperatively, which warrants a close follow-up in children operated during the amblyogenic age.