Clinical decision upon resection or observation of ocular surface dermoid lesions with the visual axis unaffected in pediatric patients.
Clinical decision upon resection or observation of ocular surface dermoid lesions with the visual axis unaffected in pediatric patients.
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DOI：
10.1186/s40064-015-1326-7
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发表时间：
2015
期刊：
影响因子：
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通讯作者：
Matsuo T
中科院分区：
文献类型：
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作者：
Matsuo T
眼表或球上皮样病变可表现为角膜缘的角膜部皮样病变或结膜穹隆的皮脂瘤。本研究的目的是回顾儿童视轴未受影响的眼表皮样瘤(I级)的临床特征，以找出关键特征，以便做出临床决定，无论是切除还是观察。这项研究涉及连续13名患有角膜缘皮样或穹隆皮脂瘤的患者，这些患者不影响视轴，在一家以转诊为基础的机构中11年来见过。手术切除8例，年龄1~18岁(中位数4岁)，其中3例同时行耳前附件切除。6例眼表呈穹隆状隆起，向颞下象限延伸1~2小时。其余2例患者均为颞部结膜穹隆皮脂瘤。6例角膜缘皮样病变患者术后散光度为0~7(中位数2.9)，2例穹窿皮脂瘤患者术后散光为0~1屈光度。所有有意义的散光患者在手术前后都戴眼镜，没有明显的屈光参差或屈光参差性弱视。初诊年龄0~2岁(中位数1岁)，末次就诊年龄2~6岁(中位数3岁)5例进行观察。扁平边缘皮样3例，持续1~2小时，穹隆状边缘皮样1例，穹隆状皮脂瘤1例。3例患者有耳前附属物。除1例圆顶状角膜缘皮样外，无一例出现散光，屈光度大于1度。总而言之，切除了圆顶状的边缘皮样，同时观察到扁平的边缘皮样。不影响视轴的角膜部皮样瘤(I级)或穹隆皮脂瘤的儿科患者手术时的年龄差异很大。手术时机受整形外科医生决定的耳前附件切除手术时间的影响。手术决定是为了美容目的，而不是为了避免弱视的医疗需要。
Ocular surface or epibulbar dermoid lesions may present as limbal dermoids at the corneal limbus or dermolipomas in the conjunctival fornix. The purpose of this study is to review clinical features of ocular surface dermoids (grade I), with the visual axis unaffected, in pediatric patients, in order to find key features for making clinical decision, either resection or observation. The study involved 13 consecutive patients with limbal dermoids or fornix dermolipomas which did not affect the visual axis, seen in 11 years at a referral-based institution. Eight patients underwent surgical resection at the age, ranging from 1 to 18 (median, 4) years, with concurrent preauricular appendage resection in 3 patients. Limbal dermoids in 6 patients presented dome-shaped elevation from the ocular surface, and extended in inferotemporal quadrant for 1–2 clock hours. The remaining 2 patients showed dermolipomas in the temporal conjunctival fornix. Postoperative astigmatism at the final visit ranged from 0 to 7 (median, 2.9) diopters in 6 patients with limbal dermoids while ranged from 0 to 1 diopters in 2 patients with fornix dermolipomas. All patients with meaningful astigmatism wore glasses before and after the surgery, resulting in no apparent ametropic or anisometropic amblyopia. Observation was chosen in 5 patients with the age at initial visit, ranging from 0 to 2 (median, 1) years, and the age at the final visit, ranging from 2 to 6 (median, 3) years. Flat limbal dermoids, extending for 1–2 clock hours, were noted in 3 patients, a dome-shaped limbal dermoid for 1 clock hour in one, and a fornix dermolipoma in one. Three patients had preauricular appendages. No patient, except for one with a dome-shaped limbal dermoid, showed astigmatism, greater than one diopter. In conclusions, dome-shaped limbal dermoids were excised while flat limbal dermoids observed. The age at surgery varied largely in pediatric patients with limbal dermoids (grade I) or fornix dermolipomas which did not affect the visual axis. The surgical timing was influenced by surgical scheduling for preauricular appendage resection, determined by a plastic surgeon. Surgical decision was made for cosmetic purposes, but not for medical needs to avoid amblyopia.