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Published on: September 17, 2014
Management of Descemet Membrane Detachment After Forceps Birth Injury
Swarupa Kancherla1, Ann Shue, Mohammad Faizan Pathan
1*Children's Eye Center, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA; and †Department of Ophthalmology, School of Medicine, University of Pittsburgh, Pittsburgh, PA.
Purpose:
To describe the clinical signs of Descemet membrane (DM) detachment due to forceps-related birth injury and its subsequent management using optical coherence tomography.
Methods:
Case report.
Results:
A 3-day-old term infant presented with left eye corneal clouding and a definitive history of traumatic forceps-assisted delivery. Despite topical therapy, corneal clouding persisted, necessitating an examination under anesthesia using ultrasound and handheld optical coherence tomography. This revealed not only a tear in DM but also a large detachment. Injection of air alone failed to achieve apposition of DM to the posterior stroma. Apposition was achieved only after penetration of the overlying cornea with the needle of a 10-0 nylon suture and release of clear viscous fluid. The cornea cleared within the first week and continued in the months to follow.
Conclusions:
Prolonged corneal edema should alert the physician to probable DM detachment after forceps-related birth injury. Injecting air alone may not be sufficient to reattach the detached DM.
