Obstetrical Forceps-Induced Descemet Membrane Tears In An Adult; Case Report

In modern medicine, forceps-induced eye trauma is a rare clinical event. This report highlights the clinical features and signs of obstetrical forceps-induced Descemet membrane tears at birth and the contrubition of the anterior segment optical coherence tomography in this condition. 

Hedi Raies Institute of Ophthalmology of Tunis, faculty of medicine of tunis, university of Tunis, Tunis, Tunisia

A 63-year-old man was referred for cataract surgery in his right eye. He was amblyopic in the same eye. On examination, in addition to the cataract, we found that he had 2 vertical tears at Descemet's level in the right cornea, through the exam we noticed that the patient had a frontal scar we discover later that it s due to forceps delivary. The Optical coherence tomography of the anterior segment (OCT-SA) note with clarity the rolled margins of torn DM and its thickening and protrusion in the anterior chamber. Based on history and clinical signs and the OCT-SA  he was diagnosed with Obstetrical forceps-induced Descemet membrane tears (FIDMT) to the right cornea.

FIDMTs are mostly asymptomatic and may be incidentally diagnosed in adolescents or adults presenting with ambyopia, glare, or photophobia. FIDMTs are commonly encountered in complicated forceps assisted delivery. Most of the patients have high corneal astigmatism due to the scarring of the DM.  Therefore, in our case the patient had steep keratometry without a high astigmatisme this may be due to the fact that the two tears in descmet membrane were more likely to be symmetrical to the vertical axis. The OCT-SA facilates the diagnosis. While some surgeons may refrain from surgical intervention because of severe amblyopia, others have described the benefits of corneal transplant in cases symptomatic due to corneal edema.