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Review
. 2021 Dec;69(12):3432-3441.
doi: 10.4103/ijo.IJO_863_21.

Obstetrical forceps-induced Descemet membrane tears

Rinky Agarwal  1 , Nidhi Kalra Singh  1 , Rajesh Sinha  1 , Namrata Sharma  1
Affiliations
Review

Obstetrical forceps-induced Descemet membrane tears

Rinky Agarwal et al. Indian J Ophthalmol. 2021 Dec.

Abstract

Obstetrical forceps-induced Descemet membrane tears (FIDMT) are usually encountered during complicated forceps-assisted deliveries. The condition may lead to significant visual debilitation in young children and is frequently ignored due to its low incidence. Undue stretch on the Descemet's membrane during the process of forceps-assisted delivery results in their vertical/oblique tear (s), which usually leads to corneal edema in early neonatal life. On its resolution, these residual tears result in visually disabling astigmatism that can lead to dense and recalcitrant amblyopia. Slit-lamp examination, anterior segment optical coherence tomography, specular microscopy, confocal microscopy, and corneal topography and tomography can be employed for its accurate diagnosis. While these can be prevented by improved perinatal care, once diagnosed, they mandate prompt refractive correction and amblyopia therapy to prevent disabling visual deterioration in affected children. In adulthood, medical and surgical management may be planned for symptomatic patients based on coexistent amblyopia as this is the major factor guiding visual prognosis. There is limited comprehensive literature in this regard, and the present review discusses the pathogenesis, clinical features, and recent developments in investigations, management, and outcomes of FIDMT during the last three decades.

Keywords: Astigmatism; Descemet membrane tears; corneal edema; forceps.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
Clinical appearance of FIDMT and corneal edema on diffuse illumination (a and c) and slit-formation (b and d)
Figure 2
Figure 2
Appearance of FIDMT on ASOCT (a–c); note the rolled margins of torn DM and its thickening and protrusion in the anterior chamber
Figure 3
Figure 3
Astigmatism and high posterior elevation on corneal tomography (a), and proliferating endothelial cells in FIDMT (b)
Figure 4
Figure 4
Vertical (a and b), horizontal (c and d), and random (e and f) orientation of FIDMT, Haab’s striae, and surgically induced DM tears, respectively
Figure 5
Figure 5
Preoperative (a) and postoperative (b) appearance after DSAEK in FIDMT-induced corneal edema; note the clearing of cornea at 6 months after surgery
Figure 6
Figure 6
Attached DSAEK graft appreciated clinically (a) and on ASOCT (b) despite residual strands of rolled DM (red arrows)
See this image and copyright information in PMC

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