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Factors predicting long-term changes in refraction after lamellar keratoscleroplasty in children with limbal dermoids
Xiangyu Fan1, Jiaxu Hong1,2, Jun Xiang1
1Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, China.
Insights
Long-term amblyopia treatment improves spherical equivalent after limbal dermoid surgery. Suture complications and graft rejection can increase astigmatism, especially with corneal encroachment.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Corneal Surgery
Background:
- Limbal dermoids are congenital tumors that can affect vision.
- Lamellar keratoscleroplasty is a surgical technique used to treat limbal dermoids.
- Understanding long-term refractive outcomes is crucial for pediatric patients.
Purpose of the Study:
- To identify predictors of long-term refractive changes after lamellar keratoscleroplasty in pediatric patients with limbal dermoids.
- To analyze factors influencing spherical equivalent and astigmatism post-surgery.
Main Methods:
- Retrospective study of 66 children with limbal dermoids and >1-year follow-up.
- Regression analyses to assess factors associated with changes in spherical equivalent, astigmatism, and mean keratometry.
- Change value calculated as postoperative minus preoperative refractive values.
Main Results:
- Long-duration amblyopia treatment predicted improved long-term spherical equivalent (β = -0.030, P < 0.001).
- Corneal encroachment, suture complications, and graft rejection correlated with increased astigmatism.
- Refractive changes were not linked to surgical age, lesion characteristics, or intraocular pressure.
Conclusions:
- Careful management of suture complications and graft rejection is vital to prevent astigmatism increase, particularly in cases with central/paracentral corneal involvement.
- Extended amblyopia treatment shows promise for better long-term spherical equivalent correction compared to astigmatism outcomes.
Objectives:
The objective of this study is to determine the factors that predict long-term changes in refraction after lamellar keratoscleroplasty in paediatric patients with limbal dermoids.
Methods:
A retrospective study of 66 children with limbal dermoids who had lamellar keratoscleroplasty correction with more than 1-year follow-up. Univariate and multivariate regression analyses were performed to investigate factors associated with the long term in refractive parameters, including spherical equivalent, astigmatism, and mean keratometry. The change value was defined as the postoperative refractive value minus the preoperative refractive value. The lower the value of changes, the more satisfied the effects on the correction of the preoperative refraction.
Results:
A total of 66 patients (mean surgical age: 3.5 ± 2.1 years) were assessed with at least 1-year follow-up. Amblyopia treatment duration was the only independent factor predicting the long-term changes in spherical equivalent between baseline and last follow-up visit (β = -0.030, P < 0.001). Lesion encroachment on the central and paracentral cornea (β = 0.502, P = 0.024), suture-related complications (β = 1.571, P < 0.001) and graft rejection (β = 0.983, P = 0.035) were significantly correlated with long-term changes in astigmatism. The long-term changes in refraction were not correlated with surgical age, lesion size, lesion depth, steroid-induced high intraocular pressure and changes in mean keratometry.
Conclusion:
Suture-related complications and graft rejection should be carefully observed and appropriately treated in order to avoid the possible postoperative increase in astigmatism, especially for patients with lesion encroachment on the central and paracentral cornea. The long-duration amblyopia treatment after surgery appears to have a better correction effect on spherical equivalent in the long term, compared with astigmatism.
