Deep Anterior Lamellar Keratoscleroplasty Using The Anterior Corneal Cap of Pre-cut Cornea for Limbal Dermoid

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Pham Ngoc Dong


Objective: To evaluate the surgical and clinical outcomes of deep anterior lamellar keratoscleroplasty using the anterior corneal cap of pre-cut donor tissues (for Descemet Stripping Automated Endothelial Keratoplasty - DSAEK) for limbal dermoid management.
Methods: Retrospective data from 39 eyes (37 patients) with limbal dermoid, treated between February 2013 and January 2017 at Vietnam National Institute of Ophthalmology.
Donor corneas for DSAEK were cut into anterior and posterior lamellae in the eye bank.
Anterior corneal caps were stored for up to 1 week in Optisol before being used as patch
grafts for deep anterior lamellar keratosleroplasty.
Results: Corneoscleral integrity was preserved in all cases. All 39 eyes had satisfactory cosmetic results after surgery. Thirteen (13) of the 39 eyes showed improved bestcorrected visual acuity after surgery. Fifteen patients’ astigmatism reduced by more than
0.75 diopters. Neo- vascularization at the graft–host junction and graft edema were noted
in 1 eyes and was treated using topical steroids.
Conclusion: The anterior cap obtained from pre-cut corneas for DSAEK can be used
as patch grafts for surgical management of limbal dermoids. This procedure achieved
satisfactory cosmetic and visual outcomes in our study, and might potentially maximize
the use of corneal tissues.
Conflicts of interest: None


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1.Mansour AM, Barber JC, Reinecke RD, Wang FM. Ocular choristomas. Surv Ophthalmol 1989;33(5):339-58.
2.Watson S, Sarris M, Kuishek M, McKelvie P, Figueria E, McCluskey P, et al. Limbal dermoid epithelium shares phenotypic characteristics common to both hair epidermal and limbal epithelial stem cells. Curr Eye Res 2013;38(8):835-42.
3.Pirouzian A. Management of pediatric corneal limbal dermoids. Clin Ophthalmol 2013;7:607-14.
4.Watts P, Michaeli-Cohen A, Abdolell M, Rootman D. Outcome of lamellar keratoplasty for limbal dermoids in children. J AAPOS 2002;6(4):209-15.
5.Lang SJ, Bohringer D, Reinhard T. Surgical management of corneal limbal dermoids: retrospective study of different techniques and use of Mitomycin C. Eye (Lond) 2014;28(7):857-62.
6.Scott JA, Tan DT. Therapeutic lamellar keratoplasty for limbal dermoids. Ophthalmology 2001;108(10):1858-67.
7.Pirouzian A, Holz H, Merrill K, Sudesh R, Karlen K: Surgical management of pediatric limbal dermoids with sutureless amniotic membrane transplantation and augmentation. J Pediatr Ophthalmol Strabismus 2012;49(2):114-9.
8.Mohan M, Mukherjee G, Panda A. Clinical evaluation and surgical intervention of limbal dermoid. Indian J Ophthalmol 1981;29(2):69-73.
9.Burillon C, Durand L. Solid dermoids of the limbus and the cornea. Ophthalmologica 1997;211(6):367-72.
10.Jeong J, Song YJ, Jung SI, Kwon JW. New surgical approach for limbal dermoids in children: simple excision, corneal tattooing, and sutureless limboconjunctival autograft. Cornea 2015;34(6):720-3.
11.Bandivadekar P, Agarwal T, Temkar S. Shave Excision With Keratopigmentation for Limbal Dermoid. Eye Contact Lens 2018;44(2):e7-9.
12.Cha DM, Shin KH, Kim KH, Kwon JW. Simple keratectomy and corneal tattooing for limbal dermoids: results of a 3-year study. Int J Ophthalmol 2013;6(4):463-6.
13.Hong S, Kim EJ, Seong GJ, Seo KY. Limbal Stem Cell Transplantation for Limbal Dermoid. Ophthalmic Surg Lasers Imaging 2010;1:2.
14.Lazzaro DR, Coe R: Repair of limbal dermoid with excision and placement of a circumlimbal pericardial graft. Eye Contact Lens 2010;36(4):228-9.
15.Xin M, Gong YR, Jiang SH, Dai CH, Li SX, Shi WY. Preoperative evaluation and outcome of corneal transplantation for limbal dermoids: a ten-year follow-up study. Int J Ophthalmol 2016;9(12):1756-60.
16.Mader TH, Stulting D: Technique for the removal of limbal dermoids. Cornea 1998;17(1):66-7.
17.Panda A, Ghose S, Khokhar S, Das H. Surgical outcomes of Epibulbar dermoids. J Pediatr Ophthalmol Strabismus 2002; 39(1):20-5.
18.Spierer O, Gologorsky D, Adler E, Forster RK. Lamellar keratoplasty with corneoscleral graft for limbal dermoids. Int J Ophthalmol 2018;11(3):512-5.
19.Wu KI, Chu HS, Pai AS, Hou YC, Lin SY, Chen WL, et al. Surgical Management of Limbal Dermoids Using Anterior Corneal Buttons From Descemet Stripping Automated Endothelial Keratoplasty Donor Tissue as Patch Grafts. Cornea 2017;36(1):64-7.
20.Amato D, Oddone F, Nubile M, Maria Colabelli Gisoldi RA, Villani CM, Pocobelli A. Pre-cut donor tissue for Descemet stripping automated keratoplasty: anterior hinged lamella on versus off. The British journal of ophthalmology 2010;94(4):519- 22.
21.Krabcova I, Studeny P, Jirsova K. Endothelial quality of pre-cut posterior corneal lamellae for Descemet membrane endothelial keratoplasty with a stromal rim (DMEK-S): two-year outcome of manual preparation in an ocular tissue bank. Cell and tissue banking 2013;14(2):325-31.
22.Pham Ngoc Dong, Truong NhuHan, Aldve J Anthony, Hoang Minh Chau. Indications for and techniques of keratoplasty at Vietnam National Institute of Ophthalmology. Int J Ophthalmolol 2015;9(3):379 -83.
23.Shen YD, Chen WL, Wang IJ, Hou YC, Hu FR. Full-thickness central corneal grafts in lamellar keratoscleroplasty to treat limbal dermoids. Ophthalmology 2005;112(11):1955.
24.Sharma N, Agarwal P, Titiyal JS, Kumar C, Sinha R, Vajpayee RB. Optimal use of donor corneal tissue: one cornea for two recipients. Cornea 2011;30(10):1140-4.
25.Chu HS, Hsieh MC, Chen YM, Hou YC, Hu FR, Chen WL. Anterior corneal buttons from DSAEK donor tissue can be stored in optisol GS for later use in tectonic lamellar patch grafting. Cornea
26.Heindl LM, Riss S, Adler W, Bucher F, Hos D, Cursiefen C. Split cornea transplantation: relationship between storage time of split donor tissue and outcome. Ophthalmology 2013;120(5):899-907.
27.Schaub F, Cursiefen C, Heindl LM. Retrospective Appraisal of Split-Cornea Transplantation: An Audit of 1141 Donor Corneas. JAMA Ophthalmol 2015; 133(9):1086-7.