Combined Excisional Biopsy and Reconstruction With Eccentric Anterior Lamellar Keratoplasty in the Treatment of Corneal Limbal Dermoid
Gurcan Dogukan Arslan, Christopher Hood, Farida Zhumageldiyeva, Victor Elner, Hakan DemirciPurpose:
Limbal corneal dermoids might invade the cornea at various depths, ranging from superficial lesions on the epithelium to deep lesions penetrating the entire corneal thickness and adjacent sclera. The aim of this report was to describe a limbal corneal dermoid with scleral ectasia at the posterior margin, requiring more complex surgical procedures.
Methods:
Ultrasound biomicroscopy (UBM) examination was used to identify posterior scleral ectasia and ciliary body prolapse; corneal limbal dermoid was treated with excision and eccentric anterior lamellar keratoplasty (ALK).
Results:
A 28-year-old woman presents with a limbal corneal dermoid in her left eye. It has been growing since her birth, and recently, it became more prominent. Her best-corrected visual acuity was 20/70, and there was an amelanotic vascularized yellowish limbal lesion superotemporally, measuring 14 × 14 × 4.2 mm. The cornea was involved between the 12 and 3 o'clock meridians with surrounding scarring. An intralesional cavity-like area with possible intraocular communication through a scleral break was detected by UBM. During the surgery, a scleral protrusion, indicating significant thinning of the sclera, was noted. Excision of the lesion and eccentric ALK were performed. After 51 months of follow-up, best-corrected visual acuity was 20/60; there was residual corneal scarring superonasally on examination.
Conclusions:
This case highlights the potential utility of UBM in identifying associated congenital abnormalities in the limbal corneal dermoid, and combined excision and reconstruction with eccentric ALK may be considered a potential surgical approach.