title: Descemet stripping automated endothelial keratoplasty in a child with descemet membrane breaks after forceps delivery.
abstract: OBJECTIVE
  To report the use of Descemet stripping automated endothelial keratoplasty (DSAEK) and to treat visual loss in Descemet membrane (DM) breaks after forceps delivery.
  
  
  METHODS
  An 8-year-old boy presented with unilateral DM ruptures secondary to forceps delivery. Central, vertically oriented DM breaks significantly decreased visual acuity. Preoperative visual acuity was 20/80. A DSAEK was performed, the DM and endothelium were stripped from the recipient, and an 8.5-mm-diameter donor button consisting of posterior stroma and healthy endothelium was folded and implanted through a 5-mm incision. An air bubble was used to press the donor tissue against the recipient cornea, allowing it to attach without sutures.
  
  
  RESULTS
  Graft dislocation in the early postoperative period required surgical repositioning of the donor lenticule, which led to excellent anatomic and functional outcomes. There was a significant and rapid improvement of the best-corrected visual acuity, which was 20/50 at the first month and 20/32 at the seventh month postoperatively.
  
  
  CONCLUSIONS
  To our knowledge, this is the first report of a DSAEK in a child with DM tears after forceps delivery. Selective replacement of posterior corneal layers with DSAEK might be a promising alternative to penetrating keratoplasty to successfully treat endothelial or DM lesions during childhood.
authors.affiliation: Hôpital Purpan, Toulouse, France.
authors.forename: Corinne
authors.initials: C
authors.lastname: Ponchel
authors.forename: François
authors.initials: F
authors.lastname: Malecaze
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Arné
authors.forename: Pierre
authors.initials: P
authors.lastname: Fournié
mesh_terms: D000328:Adult; D001720:Birth Injuries / Q000209:etiology / Q000601:surgery*; D002452:Cell Count; D002648:Child; D016039:Corneal Transplantation; D036861:Delivery, Obstetric; D003886:Descemet Membrane / Q000293:injuries* / Q000601:surgery*; D004728:Endothelium, Corneal / Q000637:transplantation*; D005131:Eye Injuries / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D009772:Obstetrical Forceps / Q000009:adverse effects*; D012421:Rupture; D014019:Tissue Donors; D014792:Visual Acuity