Indian Journal of Ophthalmology

ARTICLES
Year
: 1978  |  Volume : 26  |  Issue : 2  |  Page : 18--20

Lamellar keratoplasty in limbal dermolipomata


Gurbax Singh, S Choudhry 
 Maulana Azad Medical College and Guru Nanak Eye Centre, New Delhi, India

Correspondence Address:
Gurbax Singh
Maulana Azad Medical College and Guru Nanak Eye Centre, New Delhi
India




How to cite this article:
Singh G, Choudhry S. Lamellar keratoplasty in limbal dermolipomata.Indian J Ophthalmol 1978;26:18-20


How to cite this URL:
Singh G, Choudhry S. Lamellar keratoplasty in limbal dermolipomata. Indian J Ophthalmol [serial online] 1978 [cited 2020 Jul 3 ];26:18-20
Available from: http://www.ijo.in/text.asp?1978/26/2/18/31467


Full Text

Dermolipoma is a congenital lesion which is exclusively distributed in and around the limbal area of the eye. It appears as a fatty herniation, most often at the temporal limbus, covered by thick epithelium in which there may be eviden­ces of glandular appendages with their secretions and hair. These tumors differ from congenital dermoid cysts, which occur because of migration clefts.

No satisfactory treatment has been suggested except for a few reports on lamellar keratoplasty. In this particular article we are reporting three cases of dermolipoma of limbal area where successful lamellar keratoplasties were under­taken both from cosmetic and visual considera­tion.

 Case Report I



30 yrs male came to cornea service because of an unsightly growth arising from lower temporal limbus and extending into adjoining sclera and cornea of right eye since birth. It appeared as a fatty herniation having a size of 8 cms. and extending for about 5 mm into cornea upto mid-pupillary area with fatty infiltration and vascularisation around its border for about 1-2 mm. The anterior chamber, iris and lens were normal. Vision was counting fingers at one foot in right eye.

Dermolipoma was dissected from the cornea and sclera. It was found to extend temporally as a sub­-conjunctival mass falling off into orbit. Conjunctiva was adherent to the mass in and around limbus area. The mass was dissected out saving as much of conjunc­tiva as possible and cut as far into orbit as possible. A trephine mark 9.00 mm x 0.5 mm was made and opaque cornea dissected out. A slight opacity left in the bed was removed by secondary dissection but a small leak occurred in the bed on temporal edge of the trephined area. The lamellar graft was applied to the bed and sutured by 8-0 virgin silk. End to end suturing of conjunctiva was done.

Slight ectasia and haze of graft remained along the graft farther away from limbus, but settled with pressure bandage. Post operatively the graft was completely transparent and vision improved to 6/36.

Case II

S A: 25 yrs male presented in cornea service with a similar congenital swelling in left eye as in previous case in the lower temporal part of limbus encroaching on the cornea upto the pupillary margin. The preoperative visual acuity was finger counting 1 foot. A lamellar keratoplasty 8.00 mm x 0.3 mm size was done. Minor perforation of graft bed occurred during deep dissection. Slight haze of graft and shallowness of chamber appeared which became alight within first post-operative week. Vision improved to 6/36 post-operatively.

Case III

S.K. 10 yrs male came to cornea service with fleshy painless swelling in left temporal limbus since birth. It was extending to pupillary border and about 3 mm into sclera. A 10.00 mm x 0.45 mm lamellar graft was given after dissecting out the growth Post-operatively epithelial ulcer appeared in lower area which healed after tarsorrhaphy. Post-operatively graft was absolutely clear except slight haze in the area of healed epithelial ulcer. Vision improved to 6/60 with glasses.

 Histopathology



The histopathology of the removed masses showed epidermalization of the conjunctival epithelium anc abundant melanin pigment in the basal layer. The sub­jacent dense collagenous tissue which also contained a fair number of elastic fibres, showed skin appendages: adipose tissue and many congested dilated vessels, Bowman's membrane was destroyed at many parts and replaced by hyalinized fibrous tissue of substantia propria.

 Discussion



Dermolipomas are solid tumour of con­genital origin, usually unilateral, single and preferentially involving lower temporal limbus, These can be corneal, timbal or scleral. Dermolipomas should be removed when:­

They cause marked impairment of sight due to astigmatism or because of extension into pupillary area.There is a rapid growth. Persistent eye irritation,For cosmetic reasons and to rule out malignant growth.

Previously keratectomy was the treatment of choice but healing of raw area left a dense vascularized scar over the cornea (Swan,[4] Dailey and Lubowitz[2], Lamellar keratop­lasty was performed in one case each by Friedie[3] and Benedict[1]. Their cases improved cosmetically but the grafts became slightly hazy. Lamellar keratoplasty was per­formed in three cases of dermolipoma involving almost half of the cornea and adjacent sclera. In two cases the opacity was extending deep into stroma resulting in a minor leak during dissection. The leak caused temporary haze of the graft which settled within a week's time. Due to slight eccentricity of graft, the edge away from the limbus showed a tendency towards lifting, as occurred in one of our cases, because of early healing of the edge towards the limbus. Large graft epithelial ulcer, occurred in one case which settled with tarsorrhaphy. In all the cases a clear post-operative graft was obtained with vision improving to 6/36 in two cases and to 6/60 in one case [Figure l]a & b. The amblyopia in these cases is perhaps caused by interference in vision by dermolipoma involving the pupillary area in the early childhood.

 Special consideration in dermolipoma operation



The opacity extends deep into the stroma and a careful dissection is necessray to remove whole of the opacity. Dissection under magnifica­tion can be greatly beneficial to avoid perfora­tion of bed of host cornea during deep dissection, as occurred in our case I and II.The graft size has to be large enough so that the suture line does not encroach on to the pupillary area.Meticulous suturing is necessary in the area of the graft away from limbus to avoid giving away of the sutures, because early healing occurs in area of graft nearer the limbus which exerts a pull on the opposite edge. A slight lift of graft edge occurred in case I but settled with pressure bandage.

 Summary



Treatment of dermolipomas have been reviewed. Results of keratoplasty in three cases of dermolipoma have been presented with special reference to the surgical techniques and problems encountered during surgery with their management.

References

1Benedict, A R., 1966, J.. Red. Ophthal., 3, 28.
2Dailey' E.G.; Lubowitz; R.M., 1962, Amer J. Ophth., 53, 661.
3Friedie. R., 1953, Klin. Monatsbl, Augenheilk, 123, 228.
4Swan, K.C., 1948, Trans. Acad. Ophthal., 458.