Ophthalmic Surgery, Lasers and Imaging Retina

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Case Report 

Limbal Stem Cell Transplantation for Limbal Dermoid

Samin Hong, MD, PhD; Eun-Ji Kim, MD; Gong Je Seong, MD, PhD; Kyoung Yul Seo, MD, PhD

Abstract

Limbal dermoids are benign peripheral corneal neoplasms, which cause cosmetic problems and visual impairment. Deep dermoids may require corneal and scleral dissections such as a lamellar or even a penetrating keratoscleroplasty. In these 2 cases, the authors used an autologous limbal stem cell transplantation and achieved good results.

Abstract

Limbal dermoids are benign peripheral corneal neoplasms, which cause cosmetic problems and visual impairment. Deep dermoids may require corneal and scleral dissections such as a lamellar or even a penetrating keratoscleroplasty. In these 2 cases, the authors used an autologous limbal stem cell transplantation and achieved good results.

Limbal Stem Cell Transplantation for Limbal Dermoid

From the Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Republic of Korea.

The authors have no financial or proprietary interest in the materials presented herein.

Address correspondence to Kyoung Yul Seo, MD, PhD, Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul, 120-752 Republic of Korea.

Accepted: November 01, 2008
Posted Online: March 09, 2010

Introduction

Limbal dermoids are benign peripheral corneal neoplasms, which are present at birth, do not change in size, and are recognized by their unique appearance.1 They may cause cosmetic problems and visual impairment due to high astigmatism or the presence of lesions themselves on the visual axis.2 Although superficial lesions are easily managed with a simple excision, deeper dermoids may require corneal and scleral dissections such as a lamellar or even a penetrating keratoscleroplasty.3–6 Such a corneaoscleral graft is usually obtained from a donor globe. Instead of a conventional corneoscleral graft, the authors used an autologous limbal stem cell transplantation and achieved good results.

Case Reports

Case 1

A 4-year-old boy presented with a whitish lesion on the right eye since birth. His best-corrected visual acuity (BCVA) were 20/40 (affected eye) and 20/25 (fellow eye) with the Allen chart and corneal astigmatism were −1.50 diopters (affected eye) and zero (fellow eye). Examination showed a limbal dermoid at the 7-o’clock direction about 4.0 mm in diameter. Under general anesthesia, the lesion was carefully dissected in a lamellar fashion. A square-shaped limbal cell sheet was harvested from the 1-o’clock limbus of the same eye, and then was secured to the lesion site (Fig. 1). Without therapy for amblyopia, his BCVA reached 20/20 (both eyes) by postoperative 36 months (Fig. 2A).

Limbal Stem Cell Transplantation for Limbal Dermoid.

Figure 1. Limbal Stem Cell Transplantation for Limbal Dermoid.

(A) Case 1 at Postoperative 36 Month; (B) Case 2 at Postoperative 20 Months After Limbal Cell Transplantation for Limbal Dermoid.

Figure 2. (A) Case 1 at Postoperative 36 Month; (B) Case 2 at Postoperative 20 Months After Limbal Cell Transplantation for Limbal Dermoid.

Case 2

A 3-year-old girl presented with a whitish hairy lesion on the right eye since birth. Her BCVA were 20/200 (affected eye) and 20/25 (fellow eye) with the Snellen chart and corneal astigmatism were −2.50 diopters (affected eye) and zero (fellow eye). Examination showed a 5.0 mm in diameter limbal dermoid at the 7-o’clock direction. Full-time patching was performed for 2 years, and BCVA of the right eye reached 20/50. An operation was performed in a similar fashion as mentioned above. After 20 months, her right eye BCVA was 20/25 and left eye BCVA was 20/20 (Fig. 2B).

Discussion

Although donor ocular tissue is relatively easily obtained in the United States and other Western countries, other parts of the world for reasons be it religious or sociopolitical. Imported globes have come on the market but remain at unreasonable prices for patients to obtain. We attained successful epithelialization and good visual outcomes in both patients with dermoids by limbal stem cell autografting after removal of the dermoid. The stem cells were harvested and then subsequently repositioned from and to a single eye, so all surgical procedures were performed only in the one affected eye. This report suggests that a limbal cell autograft may lead to a novel therapeutic strategy for limbal dermoids.

References

  1. Stern GA. Peripheral corneal disease. In: Krachmer JH, Mannis MJ, Holland EJ, eds. Cornea. Philadelphia: Elsevier Mosby2005:339.
  2. Mansour AM, Barber JC, Reinecke RD, Wang FM. Ocular choristomas. Surv Ophthalmol. 1989;33:339–358. doi:10.1016/0039-6257(89)90011-8 [CrossRef]
  3. Lanzl IM, Augsburger JJ, Hertle RW, Rapuano C, Correa-Melling Z, Santa Cruz C. The role of ultrasound biomicroscopy in surgical planning for limbal dermoids. Cornea. 1998;17:604–606. doi:10.1097/00003226-199811000-00006 [CrossRef]
  4. Scott JA, Tan DT. Therapeutic lamellar keratoplasty for limbal dermoids. Ophthalmology. 2001;108:1858–1867. doi:10.1016/S0161-6420(01)00705-9 [CrossRef]
  5. Zaidman GW, Johnson B, Brown SI. Corneal transplantation in an infant with corneal dermoid. Am J Ophthalmol. 1982;93:78–83.
  6. Mansour AM, Laibson PD, Reinecke RD, Henkind P, Mikati M. Bilateral total corneal and conjunctival choristomas associated with epidermal nevus. Arch Ophthalmol. 1986;104:245–248.
Authors

From the Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Republic of Korea.

The authors have no financial or proprietary interest in the materials presented herein.

Address correspondence to Kyoung Yul Seo, MD, PhD, Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul, 120-752 Republic of Korea.

10.3928/15428877-20100215-58

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