Descemet Membrane Endothelial Keratoplasty in Corneal Endothelial Decompensation After a Forceps-Induced Corneal Birth Injury: Case Series and Technique

Supplemental Digital Content is Available in the Text. Purpose:The aim of this study was to describe the efficacy of Descemet membrane endothelial keratoplasty (DMEK) in patients with corneal endothelial decompensation secondary to a forceps-induced corneal birth injury.Methods:This was a retrospective, noncomparative, interventional case series. Four eyes of 4 patients (1 female and 3 males; mean age, 64.0 +/- 4.7 years) with corneal endothelial decompensation due to forceps-induced corneal birth injury were included. DMEK was performed in all cases, using a combined technique, including the use of intraoperative optical coherence tomography, vital staining of Descemet membrane of both host and donor, removal of scarred Descemet membrane with side-port forceps and vitreous cutter to smoothen the posterior corneal surface, epithelial peeling, and illumination for visualization. The examination included preoperative and postoperative ophthalmologic examinations: best-corrected visual acuity (converted to logarithm of the minimum angle of resolution [logMAR]), intraocular pressure, endothelial cell density (ECD), and central corneal thickness.Results:No postoperative complications were noted, and corneal transparency was maintained during follow-up (mean follow-up period, 32.0 +/- 27.0 months; range, 3-71 months). The mean best-corrected visual acuity was 0.52 +/- 0.35 logMAR preoperatively and 0.15 +/- 0.09 logMAR at the last visit. The mean postoperative ECD was 1632 +/- 631 cells/mm2 (mean ECD at baseline, 3167 cells/mm2). Central corneal thickness decreased from 640 +/- 67 mu m preoperatively to 576 +/- 58 mu m postoperatively.Conclusions:This study suggests that DMEK can be performed uneventfully in eyes with a forceps-induced corneal birth injury. The combination of surgical techniques may be an effective approach for DMEK.