Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Indian J Ophthalmol. 2021 Dec;69(12):3432-3441. doi: 10.4103/ijo.IJO_863_21.
Obstetrical forceps-induced Descemet membrane tears (FIDMT) are usually encountered during complicated forceps-assisted deliveries. The condition may lead to significant visual debilitation in young children and is frequently ignored due to its low incidence. Undue stretch on the Descemet's membrane during the process of forceps-assisted delivery results in their vertical/oblique tear (s), which usually leads to corneal edema in early neonatal life. On its resolution, these residual tears result in visually disabling astigmatism that can lead to dense and recalcitrant amblyopia. Slit-lamp examination, anterior segment optical coherence tomography, specular microscopy, confocal microscopy, and corneal topography and tomography can be employed for its accurate diagnosis. While these can be prevented by improved perinatal care, once diagnosed, they mandate prompt refractive correction and amblyopia therapy to prevent disabling visual deterioration in affected children. In adulthood, medical and surgical management may be planned for symptomatic patients based on coexistent amblyopia as this is the major factor guiding visual prognosis. There is limited comprehensive literature in this regard, and the present review discusses the pathogenesis, clinical features, and recent developments in investigations, management, and outcomes of FIDMT during the last three decades.
产钳引起的角膜后弹力层撕裂（FIDMT）通常发生在复杂的产钳辅助分娩中。这种情况可能导致幼儿视力严重受损，但由于其发病率低，常被忽视。产钳辅助分娩过程中对角膜后弹力层的过度拉伸会导致其垂直/斜向撕裂（s），这通常会导致新生儿早期角膜水肿。在其解决过程中，这些残余的撕裂会导致严重的视觉障碍性散光，从而导致严重且顽固的弱视。裂隙灯检查、眼前节光学相干断层扫描、共焦显微镜、角膜地形图和断层扫描可用于准确诊断。虽然通过改善围产期护理可以预防这些情况，但一旦确诊，就需要及时进行屈光矫正和弱视治疗，以防止受影响儿童的视力恶化。在成年期，对于有症状的患者，可以根据并存的弱视情况，计划进行药物和手术治疗，因为这是影响视力预后的主要因素。在这方面，综合文献有限，本综述讨论了过去三十年中 FIDMT 的发病机制、临床特征以及在检查、治疗和结果方面的最新进展。
