title: Case series and techniques of Descemet's Stripping Automated Endothelial Keratoplasty for severe bullous keratopathy after birth injury.
abstract: BACKGROUND
  To evaluate clinical outcomes of Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK) for severe bullous keratopathy that develop as a late complication of endothelial injury to the baby during forceps delivery at birth.
  
  
  METHODS
  Four eyes (four patients; mean age, 51.5 years) with severe bullous keratopathy as a late complication of forceps delivery at birth were enrolled. All patients had amblyopia from childhood due to cloudy cornea. Nontheless, DSAEK was indicated in these patients for the irritation and severe light sensation caused by apparent bullous change of the injured cornea. All patients underwent DSAEK and two patients had simultaneous cataract surgery. Intraoperative and postoperative complications were recorded. Postoperative donor endothelial-cell densities (ECDs) were measured prospectively at six and 12 months and compared with preoperative values. Best corrected visual acuity (BCVA) was measured at 6 and 12 months postoperatively. All cases required corneal epithelial removal; two cases with simultaneous cataract surgeries required lens anterior capsule staining by trypan blue and illumination of the cornea for visualization. There were no cases of graft dislocation or primary graft failure. Mean BCVA improved from 0.06 to 0.15 at 6 months and to 0.38 at 12 months. Postoperative ECD was 2270 cells/mm(2) (mean loss, 24.4 %) at 6 months and 2130 (mean loss, 29.1 %) at 12 months. Postoperative intraocular pressure elevation was observed in two cases, and a rejection episode occurred in one case at 4 months postoperatively.
  
  
  CONCLUSIONS
  In this case series, the clinical outcome of DSAEK for severe bullous keratopathy after forceps delivery was fair with rapid corneal clearance, which was comparable to uncomplicated cases. Cataract and DSAEK surgery was safely performed using techniques including epithelial removal, lens anterior capsule staining and illuminating the cornea, which enabled better visualization of the anterior chamber.
authors.affiliation: Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa-shi, Ishikawa-ken, 920-8641, Japan. kobaya@kenroku.kanazawa-u.ac.jp.
authors.forename: Akira
authors.initials: A
authors.lastname: Kobayashi
authors.affiliation: Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa-shi, Ishikawa-ken, 920-8641, Japan. hyoko@med.kanazawa-u.ac.jp.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Yokogawa
authors.affiliation: Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa-shi, Ishikawa-ken, 920-8641, Japan. nnnat725@med.kanazawa-u.ac.jp.
authors.forename: Natsuko
authors.initials: N
authors.lastname: Mori
authors.affiliation: Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa-shi, Ishikawa-ken, 920-8641, Japan. ksugi@med.kanazawa-u.ac.jp.
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Sugiyama
mesh_terms: D001720:Birth Injuries / Q000209:etiology / Q000601:surgery*; D002452:Cell Count; D003316:Corneal Diseases / Q000209:etiology / Q000601:surgery*; D036861:Delivery, Obstetric / Q000379:methods; D057111:Descemet Stripping Endothelial Keratoplasty / Q000379:methods*; D004728:Endothelium, Corneal / Q000293:injuries*; D005131:Eye Injuries / Q000209:etiology / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006801:Humans; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D009772:Obstetrical Forceps / Q000009:adverse effects; D018918:Phacoemulsification; D011446:Prospective Studies; D012029:Refraction, Ocular; D014792:Visual Acuity / Q000502:physiology