CLINICAL SCIENCE Results of Descemet Stripping Automated Endothelial Keratoplasty for the Treatment of Late Corneal Decompensation Secondary to Obstetrical Forceps Trauma Vincenzo Scorcia, MD,* Rocco Pietropaolo, MD,* Adriano Carnevali, MD,* Valentina De Luca, MD,* Andrea Lucisano, MD,* and Massimo Busin, MD*†‡ Purpose: 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. Methods: 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 preopera- tively and 1 year after surgery. Results: Visual acuity improved in all cases by at least 2 Snellen lines; topographic astigmatism lower than 2.5 diopters was associ- ated with better visual recovery. No intraoperative or postoperative complications were reported, and the corneas remained clear throughout the follow-up. Conclusions: 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. Key Words: forceps injury, endothelial keratoplasty, astigmatism, corneal decompensation (Cornea 2016;35:305–307) D escemet membrane (DM) breaks caused by obstetrical forceps injury are often an occasional finding during ophthalmologic examination; they appear as unilateral verti- cal or oblique striae on the inner corneal surface. 1 In addition, because of the effect of forceps compression on the affected eye, these patients also suffer from unilateral and/or asym- metric astigmatism of various degrees, which may induce amblyopia. 2 In some adults, the forceps injury is associated with progressive endothelial cell loss leading to corneal decompensation and visual loss. We report herein the out- comes of Descemet stripping automated endothelial kerato- plasty (DSAEK) performed in adult patients for the treatment of corneal decompensation induced by forceps injury. METHODS We reviewed the clinical charts of seven adult patients affected by unilateral corneal decompensation due to obstet- rical forceps injury, who underwent DSAEK at the Depart- ment of Ophthalmology of the University “Magna Graecia” (n = 4) or at the Department of Ophthalmology of Villa Igea (n = 3) between January 2010 and December 2013. All patients had had a complicated forceps-assisted delivery and had been diagnosed with relative amblyopia in the affected eye, which had not been apparently treated in any case. Institutional review board approval was obtained from the University of “Magna Graecia”; the study followed the tenets of the 1964 Declaration of Helsinki and all patients had signed a detailed informed consent. All patients underwent a routine, complete ophthalmo- logic evaluation including slit-lamp examination (Fig. 1A), intraocular pressure measurement with a Goldmann tonometer, uncorrected (UCVA) and best spectacle-corrected visual acuity (BSCVA) assessment; when corneal opacity did not allow fundus examination, a B-scan echography was performed. Anterior segment optical coherence tomography (SS-1000 CASIA, Tomey, Japan) was performed in both affected (Fig. 1B) and not-affected eyes; in particular, the topographic astigmatism was measured and compared between the 2 eyes of the same patient to evaluate the level of anisometropia induced by the forceps injury. In addition, endothelial cell density was measured using a noncontact specular microscope (EC-3000; Tomey, Japan). DSAEK was performed according to a standardized technique previously described. 3 The affected DM-endothelium Received for publication August 27, 2015; revision received October 5, 2015; accepted October 18, 2015. Published online ahead of print December 14, 2015. From the *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. M. Busin receives travel expense reimbursement and royalties from Moria (Antony, France). The remaining authors have no funding or conflicts of interest to disclose. Reprints: Vincenzo Scorcia, MD, Via dei Crociati 40, 88100 Catanzaro, Italy (e-mail: vscorcia@libero.it). Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. Cornea  Volume 35, Number 3, March 2016 www.corneajrnl.com | 305 Copyright Ó 2016 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.