Scorcia Vincenzo, Pietropaolo Rocco, Carnevali Adriano, De Luca Valentina, Lucisano Andrea, Busin Massimo
*Department of Ophthalmology, University of Magna Graecia, Catanzaro, Italy; †Department of Ophthalmology, Ospedale Privato Villa Igea, Forlì, Italy; and ‡Istituto internazionale per la Ricerca e Formazione in Oftalmologia (IRFO), Forlì, Italy.
Cornea. 2016 Mar;35(3):305-7. doi: 10.1097/ICO.0000000000000715.
To describe the clinical outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) in a series of patients affected by progressive endothelial cell loss leading to corneal decompensation with Descemet membrane (DM) breaks caused by obstetrical forceps trauma.
Seven amblyopic eyes of 7 patients affected by unilateral visual loss due to increasing corneal edema were included in the study. In all eyes, slit-lamp examination revealed typical DM breaks and diffuse corneal edema: these findings were compatible with a history of obstetrical forceps-assisted delivery. DSAEK was performed in all cases (in 3 eyes combined with phacoemulsification and intraocular lens implantation); visual acuity, refraction, corneal topography, and endothelial cell density were recorded preoperatively and 1 year after surgery.
Visual acuity improved in all cases by at least 2 Snellen lines; topographic astigmatism lower than 2.5 diopters was associated with better visual recovery. No intraoperative or postoperative complications were reported, and the corneas remained clear throughout the follow-up.
In eyes with endothelial decompensation secondary to DM breaks caused at birth by forceps injury, DSAEK can be performed uneventfully and restore cornea clarity. However, visual recovery is limited by the preexistent amblyopia, usually resulting from anisometropia and/or high-degree unilateral astigmatism. The results obtained in our patients suggest that low-degree astigmatism may be associated with better visual outcomes.
描述在一系列因产科产钳创伤导致角膜后弹力层（DM）破裂，进而出现进行性内皮细胞丢失并导致角膜失代偿的患者中，后弹力层剥离自动内皮角膜移植术（DSAEK）的临床结果。
本研究纳入了7例因角膜水肿加重导致单眼视力丧失的患者的7只弱视眼。所有患眼中，裂隙灯检查均发现典型的DM破裂和弥漫性角膜水肿：这些表现与产科产钳助产史相符。所有病例均行DSAEK手术（3只眼联合白内障超声乳化吸除及人工晶状体植入术）；术前及术后1年记录视力、屈光、角膜地形图及内皮细胞密度。
所有病例视力均至少提高2行Snellen视力表；低于2.5屈光度的地形图散光与更好的视力恢复相关。未报告术中或术后并发症，随访期间角膜保持透明。
对于因产钳损伤在出生时导致DM破裂继发内皮失代偿的患眼，DSAEK手术可顺利进行并恢复角膜透明。然而，视力恢复受先前存在的弱视限制，弱视通常由屈光参差和/或高度单侧散光引起。我们患者的结果表明，低度散光可能与更好的视力结果相关。
