PURPOSE: To investigate the long-term outcome of surgical intervention for limbal dermoids and to evaluate the safety and efficacy of tectonic lamellar keratoplasty. METHODS: This retrospective cohort study included 86 eyes that underwent tectonic lamellar keratoplasty by 5 corneal surgeons at Kyoto Prefectural University of Medicine and Baptist Eye Institute, Kyoto, Japan, from 1992 through 2024. The study subjects were categorized into 2 groups: group A, consisting of 35 eyes that underwent amblyopia treatment, and group B, consisting of 51 eyes that did not. RESULTS: Kaplan-Meier survival analysis revealed 95.3% (82 of 86 eyes) maintained clear tectonic corneal grafts with healthy ocular surfaces postoperatively. Three eyes developed psudopterygium formation, and 1 eye developed a corneal infection. Improvement of 0.2 logarithm of the minimum angle of resolution units or more because of preoperative amblyopia treatment was observed in 48.6% (17 of 35 eyes) in group A. Surgical intervention resulted in an improvement of 0.2 logarithm of the minimum angle of resolution units or more in 25.7% (9 of 35 eyes) in group A, and 15.7% (8 of 51 eyes) in group B. One case of corneal infection resulted in decreased best-corrected visual acuity. No other cases exhibited best-corrected visual acuity deterioration. CONCLUSIONS: Tectonic lamellar keratoplasty can be performed safely with very few postoperative complications, maintaining long-term corneal clarity, reasonable visual acuity, and satisfactory cosmetic results.