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Kim, Ahn, Whang, and Park: Astigmatic Analysis before and after Surgical Excision of Limbal Dermoid: Functional Outcome
Original Article

Journal of the Korean Ophthalmological Society 2017; 58(9): 1092-1098.

Published online: 18 September 2017

DOI: https://doi.org/10.3341/jkos.2017.58.9.1092

Astigmatic Analysis before and after Surgical Excision of Limbal Dermoid: Functional Outcome

Ji Hyun Kim, MD, Ye Jin Ahn, MD, Woong Joo Whang, MD, Shin Hae Park, MD, PhD

Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Address reprint requests to: Shin Hae Park, MD, PhD. Department of Ophthalmology, The Catholic University of Korea Seoul St. Mary's Hospital, #222 Banpo-daero, Seocho-gu, Seoul 06591, Korea. Tel: 82-2-2258-6204, Fax: 82-2-599-7405, vaccine@catholic.ac.kr

Received 9 March 2017       Revised 20 July 2017       Accepted 17 August 2017

©2017 The Korean Ophthalmological Society

The Korean Ophthalmological Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To analyze the length and area of limbal dermoid invading the cornea and to evaluate the effects on visual acuity and astigmatism before and after surgery.

Methods

This retrospective study included 20 eyes of 20 patients who underwent surgical removal of limbal dermoid. The preoperative and postoperative visual acuity and astigmatism level were measured. In addition, we evaluated the correlations of astigmatism with the length ratio (length of limbal dermoid invading the cornea/total corneal diameter), width ratio (width of limbal dermoid invading the cornea/total corneal diameter), and area ratio (area of limbal dermoid invading the cornea/total corneal area) using preoperative anterior segment photographs.

Results

The mean preoperative astigmatism was 0.85 ± 0.71 D in the sound eye and 3.00 ± 3.14 D in the affected eye (p = 0.004). Length, width, and area ratio of limbal dermoid have positive correlation with astigmatism (p < 0.010 for all variables), with a larger length ratio of limbal dermoid invading the cornea producing greater reduction in postoperative astigmatism (p = 0.010, r = 0.816). The amount of astigmatism was significantly higher in patients with amblyopia in the affected eye (p = 0.030). Visual acuity gain more than 2 lines was achieved in 8 among 10 patients with amblyopia under the age of 7 years through the appropriate refractive correction and occlusion 1 year after surgery.

Conclusions

Astigmatism is a major cause of amblyopia in pediatric patients with limbal dermoid. The degree of astigmatism can be predicted by the size factors of the limbal dermoid. In particular, the relative length of limbal dermoid invading the cornea has a stronger correlation with preoperative astigmatism than other factors and has correlation with postoperative reduction of astigmatism. It should be emphasized that children with limbal dermoid need appropriate refractive correction and occlusion in addition to surgical excision.

Keywords: Amblyopia, Astigmatism, Limbal dermoid

Figures and Tables

Figure 1

The parameter of limbal dermoid size by graphic program. (a) is limbal dermoid horizontal length to corneal center. (b) is distance between 2 limbal points where the limbal dermoid intersected with the limbus. (c) is area of limbal dermoid on cornea. (d) is total corneal diameter. (e) is total corneal area. Relative length is (a)/(d), relative width is (b)/(d), and relative area is (c)/(e).

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Figure 2

The preoperative astigmatism and the change of astigmatism according to the length of the central invasion of the limbal dermoid. The corneal diameter is assumed to be 11.5 mm. (A) Scatterplot graph showing a positive linear correlation between limbal dermoid length invading cornea (in millimeters) and preoperative astigmatism (in diopters). (B) Scatterplot graph showing a positive linear correlation between limbal dermoid length invading cornea (in millimeters) and variation between preoperative and postoperative astigmatism. Pre op. = preoperative; D = diopter.

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Figure 3

Double-angle scatterplots of astigmatism using AstigPLOT. Only 17 eyes with the center of the limbal dermoid located on the inferotemporal side were included. (A) Scatter plot of polar astigmatic vectors for preoperative astigmatism (n = 17). (B) Scatter plot of polar astigmatic vectors for postoperative astigmatism (n = 17). (C) Scatter plot of calculated surgically induced astigmatism (n = 17). Astigmatism was expressed on a negative scale. Blue one point represents one eye and red point represents centroid. The distance from the origin to a point represents the size of the induced corneal astigmatism, and each graph has a single size displayed. D = diopter.

jkos-58-1092-g003
Table 1

Demographic characteristics of patients

jkos-58-1092-i001

Values are presented as mean ± SD unless otherwise indicated.

Table 2

Comparison of visual acuity and refractive error between sound eye (normal eye) and affected eye (limbal dermoid eye) before surgery & comparison of visual acuity and astigmatism at affected eye before and after surgery

jkos-58-1092-i002

Values are presented as mean ± SD unless otherwise indicated.

UCVA = uncorrected visual acuity; BCVA = best corrected visual acuity; SE = spherical equivalent; D = diopter; Pre op. = preoperative; Post op. = postoperative.

*Comparison between sound eye and affected eye before surgery, Mann-Whitney U-test; †Comparison between preoperative and postoperative in affected eye, Wilcoxon signed rank test.

Notes

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (NRF-2016R1C1B1016590).

Conflicts of Interest The authors have no conflicts to disclose.

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