Obstetrical Forceps Injury to the Eye: in vivo Confocal Microscopy Evaluation

Abstract

Abstract: : Purpose: Corneal injury from forceps trauma was apparently first described in 1985 by Noves. Ultrastructural aspects of corneal lesions have been described by using electron microscopy from 1966. The goal of this study was to describe, by using in vivo confocal microscopy, the morphologic changes associated with forceps keratopaty. Methods: One eye of 42 years old male with diagnosed forceps keratopaty was examined by use of a scanning slit corneal confocal microscope (Confoscan 2.0). The morphology of corneal surface epithelial cells, basal epithelial cells, subbasal nerve plexus, Bowman's layer, stromal keratocytes, and endothelium was analyzed. Results:At confocal microscopy superficial and basal epithelial cells appeared within normal limits, and the subepithelial nerve plexus showed normal thin fibers. In the stroma, non–homogeneous distribution of keratocytes, with anterior stromal edema, was observed. At the level of Descemet’s membrane, confocal microscopy demonstrated cicatricial highly reflective scroll–structures above the endothelial cell layer. Severe reduction of endothelial cell density (mean value 450 cells/mm2) with lesions and distorsions of the cell layer profile was observed in the corneal apex, whereas cell density of 973 cells/mm2 with a mild degree of pleomorhism and polymegathism was observed in the periferical cornea. Conclusions: The Authors confirm the importance of confocal microscopy in corneal diseases; this diagnostic tool allows to identify any structural anomalies, especially where corneal opacity may prevent examination of the endothelium by specular microscopy.

Keywords: microscopy: confocal/tunneling • cornea: stroma and keratocytes • cornea: clinical science