Purpose: 
Several authors have advocated lamellar keratoplasty for the treatment of limbal dermoids. However this procedure may be complicated by  graft opacification, delayed epithelialization and induced astigmatism leading to amblyopia, especially in young children. We report the visual, refractive and cosmetic outcomes of simple excision of limbal dermoids outside the visual axis and without involvement of the Descemet's membrane in children during the amblyogenic period.
Study design: 
Retrospective chart review. 
Methods: 
We reviewed the charts of all patients aged less than 8 year undergoing limbal dermoid excision under our care between 2000 and present. Nineteen patient's charts could be accessed and included. The mean [range] age was 4.2 years [9 months - 8 years] with an average follow-up of 4 years [1 months to 12 years]. The visual acuity, degree of amblyopia, astigmatism, cosmesis and complications were reported. 
Results: 
The indication for excision was amblyopia and/or astigmatism in 9/19 patients, cosmesis in 6, discomfort in 3, unspecified 1. The mean [range] change in visual acuity from pre-to post-operative visit was +1 [-2 to +5] lines. Except for 1 patient, there was no significant improvement of amblyopia after surgery. The mean ±SD cylinder of astigmatism was 3.2 ± 1.8 pre-operatively and 3.5 ± 2.2 at the last visit. The axis of astigmatism did not change significantly. The epithelial defect healed in a mean [range] time of 13 [2 - 21] days. One patient with extensive involvement had residual dermoid tissue. 
Conclusions: 
Although this surgery has obvious cosmetic benefits, we found no significant change in visual acuity or astigmatism after excision of limbal dermoids in young children. No complications were encountered and the replacement of the limbal lesion by conjunctival tissue led to good cosmetic outcomes. Since no post-operative reduction in astigmatism can be expected from this surgery, families should be counseled pre-operatively that spectacle correction and patching will remain essential in the post-operative management of amblyopia.

Simple excision for the management of limbal dermoids in young children

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