Late corneal decompensation after obstetrical forceps ocular trauma at birth

A 51-year-old woman presented with recurrent painful ulcers in her left cornea over a period of six months. She had a history of a birth that required obstetrical forceps delivery and poor vision in the left eye since childhood, resulting in deep amblyopia. At the level of Desçemet’s membrane, confocal microscopy demonstrated cicatricial highly reflective scroll-structures above the endothelial cell layer. Penetrating keratoplasty and cataract phacoemulsification with intraocular lens implantation were performed in the left eye. The indications for penetrating keratoplasty were related to the painful corneal ulcers, as there was little prospect of visual improvement. The histological findings were consistent with corneal endothelial decompensation and associated old ruptures in Desçemet’s membrane and posterior stroma scarring.