MANAGEMENT OF EXTENSIVE OCULAR SURFACE LIPODERMOID INVOLVING THE CORNEA IN CHILDREN
Published 2023 - 27th ESCRS Winter Meeting
Reference: O57 | Type: Free Paper Submission | DOI: 10.82333/gbby-rz26
Authors: Elena Franco* 1 , Meghal Gagrani 2 , Vaitheeswaran G. Lalgudi 3 , Parth R. Shah 4 , Phoebe Lenhart 5 , Rahul Bhola 6 , Ken K. Nischal 7
1Division of Paediatric Ophthalmology, Strabismus, and Adult Motility,UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA,PITTSBURGH,United States, 2Division of Paediatric Ophthalmology, Strabismus, and Adult Motility,UPMC Children's Hospital of Pittsburgh,PITTSBURGH,United States, 3Department of Cornea and Refractive surgery, University of Ottawa Eye Institute ,The Ottawa Hospital, Ottawa,Ontario,Canada, 4Department of Ophthalmology,Sydney Children's Hospital,Sydney,Australia, 5Section of Pediatric Ophthalmology, Department of Ophthalmology,Emory University School of Medicine, 1365B Clifton Road, NE, Suite 5400,ATLANTA,United States, 6Division of Ophthalmology,CHOC Children's Hospital,Orange,United States, 7Division of Paediatric Ophthalmology, Strabismus, and Adult Motility,UPMC Children’s Hospital of Pittsburgh,PITTSBURGH,United States
Purpose
Ocular surface lipodermoids with corneal involvement may require surgical intervention; if deep, ocular surface reconstruction with lamellar corneal tissue or amniotic membrane may be needed. We describe a staged technique using autologous ipsilateral simple limbal epithelial transplantation (SLET).
Setting
Methods
After verifying sparing of Descemet Membrane, the conjunctival portion of the lipodermoid was debulked in the first stage. Six weeks later, the corneal portion was excised, followed by autologous ipsilateral SLET to promote rapid re-epithelialization of the residual stromal bed. A temporary tarsorrhaphy was used for patient comfort and to expedite ocular surface healing.
Results
Three eyes of three children with grade III large ocular surface lipodermoids which encroached the visual axis and hindered proper eyelid closure underwent surgery without complications. In all cases, the visual axis was cleared, and eyelid closure was improved. At last follow-up (mean 35.7 months, median 36.0 months), the bed of the original dermoid showed minimal haze in one case, whilst two eyes developed a small pseudo-pterygium; best spectacle corrected visual acuity (BSCVA) improved from 20/200 to 20/70 in the first case, from fix and follow (F&F) to 20/50 in the second case, and remained F&F in the last case, but this child had congenital hydrocephalus with severe developmental delay.
Conclusion
This surgical technique is a promising option for children with grade III large ocular surface lipodermoids given its effectiveness in clearing the visual axis and in improving eyelid closure. Moreover, it does not require lamellar corneal transplantation or intervention to the fellow eye.