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Year : 2022  |  Volume : 2  |  Issue : 3  |  Page : 657-664

The tale of torn Descemet's membrane: Conception of diagnosis from a story well heard

Cornea and Anterior Segment Service, L. V. Prasad Eye Institute, Bhubaneswar, Odisha, India

Correspondence Address:
Dr. Neha G Madan
Former Fellow LVPEI, Bhubaneswar, Odisha
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_989_21

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To report three cases of late presentations of forceps birth trauma leading to DM tear and their management. Forceps delivery has become a rare method of child delivery in the modern clinical era. However, in the clinics, we still see patients with Descemet's membrane (DM) tear who have had ocular birth trauma with forceps. Most of the time, it is an incidental finding. Forceps injuries are usually unilateral and affect the left eye as the most common fetal head position is left occiput anterior. In the immediate postpartum period, the rupture in the DM leads to corneal edema, which eventually disappears, leaving the visible edges of the break. In the late presentations, patients can have high myopic astigmatism (steep cornea) and secondary amblyopia, which can mimic unilateral keratoconus and, later in life, can lead to corneal endothelial decompensation leading to bullous keratopathy. Here we report three cases of DM tear due to forceps injury with three late presentations. Patient 1 came with bullous keratopathy; patient 2 presented with high myopic astigmatism, amblyopia, and beaten metal appearance in between the torn edges; and patient 3 presented as keratoconus. To conclude, this case series highlights the various clinical features and signs of forceps induced birth injury to the cornea. In this report, the clinical history, ocular examination, and optical coherence tomography scan confirmed the diagnosis. Early rehabilitation with glasses or contact lenses can prevent the development of deep amblyopia. Corneal decompensation can be a presentation later in life; thus, these patients should have a close follow up. Endothelial keratoplasty helps in visual rehabilitation in cases where bullous keratopathy has developed, which can be up to the preoperative amblyopia state.

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