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PHOTO ESSAY
Year : 2020  |  Volume : 32  |  Issue : 2  |  Page : 189-190

This Descemet's membrane has a story! Birth trauma


1 iTek Vision Centre, Sector 51, Noida, Uttar Pradesh; Department of Cornea, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
2 Department of Refractive surgery, Sri Sankaradeva Nethralaya, Guwahati, Assam, India

Date of Submission29-Feb-2020
Date of Acceptance30-Apr-2020
Date of Web Publication25-Aug-2020

Correspondence Address:
Dr. Pooja Shukla
iTek Vision Centre, Sector 51, Noida, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kjo.kjo_24_20

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  Abstract 


We report a case of a 27-year-old male presenting with blurred vision in one eye which was discovered at an army recruitment camp. He was examined and subsequently diagnosed to be having Descemet's membrane tears, due to forceps-induced birth trauma with amblyopia. His vision improved with a rigid gas permeable contact lens to 20/60.

Keywords: Astigmatism, Descemet's membrane tears, forceps-induced birth trauma


How to cite this article:
Shukla P, Kumari N, Chirania PJ, Agarwal B. This Descemet's membrane has a story! Birth trauma. Kerala J Ophthalmol 2020;32:189-90

How to cite this URL:
Shukla P, Kumari N, Chirania PJ, Agarwal B. This Descemet's membrane has a story! Birth trauma. Kerala J Ophthalmol [serial online] 2020 [cited 2020 Oct 29];32:189-90. Available from: http://www.kjophthal.com/text.asp?2020/32/2/189/293291




  Case Top


A 27-year-old male presented with blurred vision in the left eye, discovered when he appeared for an army recruitment screening camp. Best-corrected visual acuity was 20/20 in the right eye and 20/300 in the left eye. Examination revealed multiple vertically oriented tears in the Descemet's membrane (DM) with rolled edges and clear and compact intervening cornea [Figure 1]a, [Figure 1]b and [Figure 1]d. Posterior-segment evaluation revealed no abnormality. There was a definitive history of forceps-assisted delivery. A scar on the left maxillofacial area [Figure 2]b further affirmed the diagnosis of a birth injury due to forceps-assisted delivery. Specular microscopy revealed marked pleomorphism and polymegathism [Figure 2]a, with a peripheral cell density of 1575. A rigid gas permeable (RGP) contact lens trial improved his vision to 20/60.
Figure 1: (a) Slit lamp photograph (×10) of the left eye in diffuse illumination showing multiple vertically oriented tears in the Descemet's membrane. (b) A slit section of the same eye with glassy ridge-like appearance of the tears and clear and compact intervening cornea. (c) Significant topographical astigmatism (Cyl − 4.85 D), note the axis of astigmatism is parallel to the axis of the tears. (d) Slit lamp picture taken in retroillumination highlighting rolled edges of the Descemet's membrane

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Figure 2: (a) Polymegathism on specular microscopy. (b) A deep scar in the left maxillofacial area

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  Discussion Top


Breaks in the DM due to birth trauma can be easily distinguished from the horizontal random breaks of congenital glaucoma, which are concentric to the limbus. Left eyes seem to be affected more commonly than right eyes because neonates usually present in the left occiput-anterior position.[1] It is hypothesized that the tip of the forceps slips over the anterior orbital rim causing vertical compression and horizontal distension of the globe, thus elevating the intraocular pressure acutely and resulting in tears of the nonelastic DM.[1],[2] The young endothelium resurfaces the DM defect and the postnatal corneal edema clears. The tears are seen as clear, glassy ridges in the posterior cornea evident on retroillumination.[1] A large proportion of cases have high Degrees of astigmatism [Figure 1]c contributing to poor vision.[1],[2] Management options include spectacles, RGP lenses, and keratoplasty.

DM tears due to birth injury are quite uncommon in the present era, owing to good prenatal care, planning, and increasing Caesarian Section rates. As visual problems go undiagnosed until the child realizes or secondary complications develop, it also adds to the existing burden of amblyopia.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Mannis MJ, Holland EJ. Cornea. 4th ed. Philadelphia, USA: Elsevier; 2017. p. 211-3.  Back to cited text no. 1
    
2.
Ruba A, Sathish S. Forceps-induced birth injury to the cornea. BMJ Case Rep 2014;2014:Bcr-2013-201786.  Back to cited text no. 2
    


    Figures

  [Figure 1], [Figure 2]



 

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