Progressive large pediatric corneal limbal dermoid management with tissue glue-assisted monolayer amniotic membrane transplantation

Abstract

Rationale:Limbal dermoids are choristomas known as congenital benign tumors found in abnormal locations. Despite the benign nature, enlarging limbal dermoids may cause visual abnormalities by cornea infiltration with fat component, visual axis invasion, gradually induced corneal astigmatism, and finally result in anisometropic amblyopia. Here we report a rare case of progressive, large pediatric corneal limbal dermoid in a newborn, managed with tissue glue-assisted monolayer amniotic membrane transplantation.Patient concerns:A 1-day-old male baby (gestational age, 36 ± 6 weeks; birth body weight, 2785 gram) presented to our clinic with a whitish mass on his right eye since birth.Diagnosis:Ocular examination revealed a solid, whitish-yellow, and ovoid mass with central keratinized epithelium over the superior limbus; the lesion covered two-thirds of the cornea with rapid progression in size. The final pathological examination revealed that the lesion is composed of keratotic lining squamous epithelium resembling epidermis, underling dermal fibrotic connective tissue, and mature fat.Interventions:The patient underwent deep lamellar excision followed by mitomycin C (MMC) soaking (0.2 mg/mL, 3 minutes) and tissue glue-assisted monolayer amniotic membrane transplantation with the ring conformer at 2 months of age.Outcomes:The ring conformer was smoothly removed 2 weeks after the operation. The patient showed a smooth healing process with less pain and rapid corneal re-epithelization. The ocular surface was stable during the follow-up visits, and no complications were detected. Only mild post-operative scarring over the incision wound was observed.Lessons:Although a combination of excision, lamellar keratoplasty, and multilayer amniotic membrane and limbal stem cell transplantation is advocated for the treatment of grade II and III pediatric corneal limbal dermoids, the procedure used in this study offers an alternative surgical approach. However, because of the large size of the lesion and the young age of the patient, the management of amblyopia with visual rehabilitation and corneal transplantation is still needed in the future.

Split cornea transplantation in anterior lamellar keratoplasty for limbal dermoid surgery: a case report

“…Surgical techniques include simple excision to the lamellar, penetrating keratoplasty with a corneal relaxing incision, a corneal-limbal-scleral graft transplant, and surgical excision followed by sutureless multilayered amniotic membrane transplantation or pericardial patch graft, depending on the depth, size, and placement of the lesion. [4][5][6][7][8] The limbal dermoid, in this case, was categorized as deeper-Grade I since it was 4.5 mm in diameter (<5 mm) and extended half the depth of the stroma (>100 μm). 9 We performed partial thickness corneal splitting, followed by lamellar delineation and partial thickness corneoscleral graft implantation in accordance with the recommendation from Pirouzian et al's 9 study on pediatric corneal limbal dermoid management.…”

“…Larger lesions covering the entire cornea and extending through the structures between the anterior surface of the eyeball and the pigmented epithelium of the iris are classified as grade III limbal dermoid. 4 Deciding which technique to apply should involve an imaging study to measure lesion depth. Simple lesion excision, lamellar keratoplasty, penetrating keratoplasty, lamellar keratoplasty with a full-thickness corneal graft, excision with a pericardial patch graft, and fibrin glue-assisted multilayered amniotic membrane transplantation, with or without a limbal allograft, are among the surgical techniques available.…”

Treatment of corneal dermoid with lenticules from small incision lenticule extraction surgery: a surgery assisted by fibrin glue

“…Besides, a new blood-derived product-fibrin glue, which has a unique mechanism of action that mimics the common pathway of coagulation, has been widely used in clinical surgical treatment for its character of adhesion, preventing wound hemostasis and low biological toxicity [20][21][22] . It has been also used in many ophthalmic surgeries, such as amniotic membrane (AM) transplantation, pterygium or strabismus surgery, and even vitreoretinal or cataract surgeries, etc [23][24][25][26][27] . However, its safety and benefits in ophthalmic surgeries need to be further verified.…”