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Forceps delivery-induced astigmatism

Poster Details

First Author: P.Salvanos NORWAY

Co Author(s):    T. Oppedal              

Abstract Details

Purpose:

To present an interesting case of unilateral corneal astigmatism after forceps delivery.

Setting:

A 5-year-old boy referred to the Department of Ophthalmology, University of Oslo.

Methods:

A 5-year-old boy was referred due to unilateral astigmatism and treatment-resistant amblyopia in the right eye (OD). History was free for prior disease, apart from a wound temporal to the lateral canthus and right eyelid swelling after forceps delivery. As documented from perinatal history, corneal edema and reduced red reflex were seen at the second postnatal day. Red reflex normalized by day 6 and ophthalmological follow-up did not show any anatomical changes at 3 months. Examination at the age of two revealed high astigmatism and amblyopia OD. The patient received spectacle correction and patching of the left eye (OS).

Results:

No visual improvement was seen at the age of 5, with best-corrected visual acuity 0.2 OD with -4 D of astigmatic correction at 60° and 1.0 OS uncorrected. Clinical examination revealed three oblique lines of Haab striae vertical to the astigmatic axis in the right cornea. Funduscopy and intraocular pressure were normal. No strabismus, abnormalities in dark adaptation or color vision were seen. Descemet's membrane appeared thickened on Pentacam imaging. The patient continued with spectacle correction. A trial to discontinue occlusion was unsuccessful.

Conclusions:

There are only a few references that perinatal conditions are causing factors to monocular astigmatism. Direct eye compression in the orbit by the forceps during labor may lead to multiple ruptures in Descemet’s membrane, and therefore severe astigmatism and intractable amblyopia. Corneal decompensation can occur later in life. Perinatal conditions should be considered as a cause when evaluating children with monocular astigmatism. Care should be taken to protect the eyes and other vital organs during delivery. Treatment of the resulting amblyopia is challenging. FINANCIAL DISCLOUSRE: NONE

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