Purpose: To analyze the clinical characteristics of corneal trauma caused by forceps delivery.
Subjects and methods: In this retrospective study, we examined the medical records of patients who visited the Department of Ophthalmology at University Hospital, Kyoto Prefectural University of Medicine between 2004 and 2020 and in whom corneal trauma caused by forceps delivery was reported. In all patients, the age at the initial visit, injured eye (i. e., right or left eye), best-corrected visual acuity (BCVA: logMAR) at initial examination, Descemet's membrane (DM) rupture angle, corneal astigmatism [diopters (D)], spherical equivalent power, axial length (AL), corneal endothelial cell density (ECD), and treatments administered were analyzed.
Results: Among 16 patients (10 males, 6 females; mean age: 56.8±10.8 years), the cornea trauma was in the right and left eyes in 14 (87.5%) and 2 (12.5%), mean BCVA at initial examination was 1.2±0.8 in the affected eye and -0.07±0.2 in the unaffected healthy eye, and the DM rupture angle was vertical in 11 patients. Mean corneal astigmatism in the affected and healthy eyes were 3.60±1.80 and 0.80±0.40 D, respectively (p<0.0001). The mean spherical equivalent powers in the affected and healthy eyes were -5.70±6.60 and -1.40±1.60 D, respectively (p<0.05), indicating that there was a significantly higher degree of myopia in the affected eyes. When AL could be measured in both the affected and healthy eyes, the mean ALs were 25.0±1.0 and 24.2±0.6 mm, respectively. The mean corneal ECDs were 912±300/mm2 (measurement was not possible in eight patients) and 2739±263/mm2, respectively (p<0.0001). Further, four patients underwent corneal endothelial keratoplasty and one underwent penetrating keratoplasty.
Conclusions: Corneal trauma and DM rupture caused by forceps delivery was common in the right eye, and it caused decreased corneal ECD. When corneal ECD decreases, causing bullous keratopathy, corneal transplantation (such as corneal endothelial transplantation) is necessary.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 125: 668-672, 2021.
