Excision of Large Conjuctival Choristoma

I believe this choristoma may represent a variant of a limbal dermoid.  Excision in this case was performed at 6 weeks of age due to amblyopia concerns.  The patient also had some anterior segment abnormalities. 

This is Richard Allen at oculosurg.com.  This video demonstrates the excision of a large choristoma that is attached to the conjunctiva in a young patient.  As is demonstrated, the lesion has no attachment to the upper or lower eyelids and is temporal to the cornea.  It may be a variant of a limbal dermoid, but there is no attachment to the cornea.  There appears to be a small stalk, that is attached to the underlying conjunctiva.  The worry in these patients is that there could be deeper attachment to the sclera and the sclera could be thin in this area.  Excision could potentially cause a defect in the sclera that would need to be repaired with donor sclera.  Excision was performed at an early age due to amblyopia concerns.  Also, as one can see, there are some anterior segment abnormalities.  Lidocaine with epinephrine is injected subconjunctivally around the lesion to aid in hemostasis.  Westcott scissors are then used to make an incision through the conjunctiva adjacent to the area of attachment.  This is then extended 360 degrees around the attachment.  The area of the attachment is then slowly transected, to determine the depth of the attachment and if there is any scleral thinning.  Fortunately, the lesion was able to be excised without any defect in the sclera.  The small area of the attachment is demonstrated on the lesion.  Hemostasis is attained with the bipolar cautery.  The conjunctiva is then widely undermined.  The conjunctiva at the limbus is excised which is thickened.  A small peritomy is performed superior and inferiorly to mobilize the conjunctiva.  The defect is then closed with interrupted, buried 7-0 Vicryl sutures.