Full-thickness central corneal grafts in lamellar keratoscleroplasty to treat limbal dermoids.

PURPOSE

To assess the surgical outcomes in patients who underwent lamellar keratoscleroplasty with full-thickness central corneal grafts for limbal dermoids.

DESIGN

Retrospective, noncomparative, analysis of a consecutive case series with chart review.

PARTICIPANTS

Ten patients (6 male, 4 female; mean age, 12.3+/-5.0 years; range, 5.7-22.4 years) with 10 limbal dermoids in 10 eyes undergoing lamellar keratoscleroplasty with full-thickness central corneal grafts between 1992 and 2003 at National Taiwan University Hospital were studied.

METHODS

The medical records and external eye photographs were reviewed.

MAIN OUTCOME MEASURES

Best-corrected visual acuity (BCVA), corneal astigmatism and topography, cosmetic outcomes, and surgical complications were measured as outcome indicators. For analysis of the surgical effect on corneal astigmatism, the 9 patients with topographic data available were divided into 2 groups according to their preoperative corneal astigmatism (group 1, > or =6 diopters [D]; group 2, <6 D).

RESULTS

The mean earliest recorded BCVA and the latest postoperative BCVA were 6/30 and 6/10, respectively, and the improvement of BCVA after operation combined with amblyopia treatment was 4.9+/-3.6 lines on a Snellen chart. Patients with preoperative astigmatism > or =6.0 D (9.7+/-1.0 D; n = 4) were found to have a marked decrease in astigmatism after surgery (astigmatism change, 5.2+/-1.7 D). Patients with preoperative astigmatism <6.0 D (3.4+/-0.2 D; n = 5) were found to have an insignificant increase in astigmatism after surgery (astigmatism change, 0.0+/-0.6 D). After surgery, significant corneal opacity was found in 1 patient; mild bluish scleral hue was found in 3 patients. Surgical complications included prolonged reepithelialization, interface neovascularization, graft rejection, and steroid glaucoma.

CONCLUSIONS

Using full-thickness central corneal grafts in lamellar keratoscleroplasty for limbal dermoids achieved good cosmetic results with limited postoperative complications. Operation may markedly reduce corneal astigmatism in patients with high preoperative corneal astigmatism. Visual prognosis is good in patients undergoing surgery combined with adequate amblyopia treatment.