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Gurnani B, Kaur K, Chaudhary S, Kaur RP, Nayak S, Mishra D, Balakrishnan H, Parkash RO, Morya AK, Porwal A. Pediatric corneal transplantation: techniques, challenges, and outcomes. Ther Adv Ophthalmol 2024; 16:25158414241237906. [PMID: 38533487 PMCID: PMC10964464 DOI: 10.1177/25158414241237906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/13/2024] [Indexed: 03/28/2024] Open
Abstract
Pediatric corneal transplant is a highly demanding and technically challenging procedure for the cornea surgeon in today's era. These cases pose unique challenges in clinical and surgical management. The indications of pediatric corneal transplant can be therapeutic, tectonic, optical, and cosmetic. Pediatric patients undergoing corneal transplants are at a high risk of graft infection, failure, rejection, dehiscence, and amblyopia due to young age, robust immune system, increased incidence of trauma, and compliance issues. The other factors contributing to graft failure can be allograft rejection, secondary glaucoma, corneal vascularization, multiple surgeries, vitreous prolapse, and lack of treatment compliance. A successful corneal transplant in children depends on meticulous preoperative evaluation, uneventful surgery, the expertise of a corneal surgeon, and regular and timely postoperative follow-up. Therapeutic and optical penetrating keratoplasty are the most commonly performed transplants in children. However, with the advancements in surgical technique and management protocol, the current focus has shifted toward lamellar keratoplasty. Lamellar keratoplasty offers early visual recovery and potentially fewer complications. Visual rehabilitation through corneal transplant in otherwise blind eyes can be a boon for the children. Recently, keratoprostheses have been promising in children with multiple graft failures. The current review gives insights into epidemiology, etiology, indications, clinical characteristics, investigations, management options, recent advances, and the future of pediatric corneal transplants. As surgical techniques continue to grow and comprehension of pediatric corneal transplants is improving, we can safeguard these eyes with the best possible anatomical and functional outcomes.
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Affiliation(s)
| | - Kirandeep Kaur
- Cataract, Paediatric Ophthalmology and Strabismus, India
- ASG Eye Hospital, Jodhpur, Rajasthan, India
| | | | | | - Swatishree Nayak
- All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Deepak Mishra
- Regional Institute of Ophthalmology, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | | | | | - Arvind Kumar Morya
- Cataract, Glaucoma, Refractive, Squint Paediatric Ophthalmology and Medical Retina Services, Department of Ophthalmology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Amit Porwal
- Head of the Department, Glaucoma Services, Choitram Netralaya, Indore, Madhya Pradesh, India
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Kasamatsu H, Yagi-Yaguchi Y, Yamaguchi T, Nishisako S, Murata T, Shimazaki J. Corneal higher-order aberrations in corneal endothelial decompensation secondary to obstetric forceps injury. Sci Rep 2023; 13:5389. [PMID: 37012353 PMCID: PMC10070416 DOI: 10.1038/s41598-023-32683-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/31/2023] [Indexed: 04/05/2023] Open
Abstract
Forceps corneal injuries during infant delivery cause Descemet membrane (DM) breaks, that cause corneal astigmatism and corneal endothelial decompensation. The aim of this study is to characterise corneal higher-order aberrations (HOAs) and corneal topographic patterns in corneal endothelial decompensation due to obstetric forceps injury. This retrospective study included 23 eyes of 21 patients (54.0 ± 9.0 years old) with forceps corneal injury, and 18 healthy controls. HOAs and coma aberrations were significantly larger in forceps injury (1.05 [0.76-1.98] μm, and 0.83 [0.58-1.69], respectively) than in healthy controls (0.10 [0.08-0.11], and 0.06 [0.05-0.07], respectively, both P < 0.0001). Patient visual acuity was positively correlated with coma aberration (rs = 0.482, P = 0.023). The most common topographic patterns were those of protrusion and regular astigmatism (both, six eyes, 26.1%), followed by asymmetric (five eyes, 21.7%), and flattening (four eyes, 17.4%). These results indicate that increased corneal HOAs are associated with decreased visual acuity in corneal endothelial decompensation with DM breaks and corneal topography exhibits various patterns in forceps injury.
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Affiliation(s)
- Hirotsugu Kasamatsu
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, 5-11-13, Sugano, Ichikawa, Chiba, 272-8513, Japan
- Department of Ophthalmology, Shinshu University School of Medicine, Nagano, Japan
| | - Yukari Yagi-Yaguchi
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, 5-11-13, Sugano, Ichikawa, Chiba, 272-8513, Japan
| | - Takefumi Yamaguchi
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, 5-11-13, Sugano, Ichikawa, Chiba, 272-8513, Japan.
| | - Sota Nishisako
- Cornea Center and Eye Bank, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan
| | - Toshinori Murata
- Department of Ophthalmology, Shinshu University School of Medicine, Nagano, Japan
| | - Jun Shimazaki
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, 5-11-13, Sugano, Ichikawa, Chiba, 272-8513, Japan
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Gupta S, Mahalingam K, Singh A, Selvan H, Somarajan BI, Gupta V. Posterior corneal morphological changes in primary congenital glaucoma. Indian J Ophthalmol 2022; 70:2571-2577. [PMID: 35791159 PMCID: PMC9426191 DOI: 10.4103/ijo.ijo_317_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Purpose: To compare posterior corneal morphology between older treated and younger untreated children with primary congenital glaucoma (PCG) using anterior segment optical coherence tomography (ASOCT) and intraoperative OCT (iOCT), respectively. Methods: In this comparative study, ASOCT of older PCG children were compared with iOCT of younger untreated PCG patients. Differences between the two groups with respect to posterior corneal morphology were studied. Results: Observed morphological patterns within posterior cornea in older treated (age: 72–300 months) children (87 eyes) included Descemet’s membrane (DM) excrescences (70%), thickened DM (35%), intracameral twin protuberances (92%), and DM detachment (26%). Changes within pre-Descemet’s layer (PDL) (28%) included thickening, breaks, and detachments. Extent of Haab’s striae was associated with thickness of DM/PDL complex (P = 0.008) when analyzed in the treated group. In contrast, in the untreated group (n = 53 eyes, age 1–63 months), posterior corneal changes were limited to diffuse hyper-reflectivity of the DM/PDL complex, with absence of DM tears. Conclusion: Posterior cornea thickens and Haab’s striae become more circumscribed in eyes of older treated children compared to untreated PCG eyes, probably reflecting a healing response of posterior cornea over time.
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Affiliation(s)
- Shikha Gupta
- Glaucoma Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Karthikeyan Mahalingam
- Glaucoma Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Abhishek Singh
- Glaucoma Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Harathy Selvan
- Glaucoma Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Bindu I Somarajan
- Glaucoma Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Viney Gupta
- Glaucoma Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Agarwal R, Singh NK, Sinha R, Sharma N. Obstetrical forceps-induced Descemet membrane tears. Indian J Ophthalmol 2021; 69:3432-3441. [PMID: 34826970 PMCID: PMC8837337 DOI: 10.4103/ijo.ijo_863_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Obstetrical forceps-induced Descemet membrane tears (FIDMT) are usually encountered during complicated forceps-assisted deliveries. The condition may lead to significant visual debilitation in young children and is frequently ignored due to its low incidence. Undue stretch on the Descemet's membrane during the process of forceps-assisted delivery results in their vertical/oblique tear (s), which usually leads to corneal edema in early neonatal life. On its resolution, these residual tears result in visually disabling astigmatism that can lead to dense and recalcitrant amblyopia. Slit-lamp examination, anterior segment optical coherence tomography, specular microscopy, confocal microscopy, and corneal topography and tomography can be employed for its accurate diagnosis. While these can be prevented by improved perinatal care, once diagnosed, they mandate prompt refractive correction and amblyopia therapy to prevent disabling visual deterioration in affected children. In adulthood, medical and surgical management may be planned for symptomatic patients based on coexistent amblyopia as this is the major factor guiding visual prognosis. There is limited comprehensive literature in this regard, and the present review discusses the pathogenesis, clinical features, and recent developments in investigations, management, and outcomes of FIDMT during the last three decades.
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Affiliation(s)
- Rinky Agarwal
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Nidhi Kalra Singh
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Sinha
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Namrata Sharma
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Jiang Y. In-depth Understanding and Prevention of Cataract Surgery-Related Descemet Membrane Detachment. JAMA Ophthalmol 2021; 139:155-156. [PMID: 33300962 DOI: 10.1001/jamaophthalmol.2020.5395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Yuzhen Jiang
- Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, England
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Diaz-Aljaro P, Monés-Liivina A, Romanic-Bubalo N, Castillo Capponi F, Sabala-Llopart A. Management of Descemet membrane detachment secondary to forceps assisted delivery in a newborn. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2020; 95:447-450. [PMID: 32616372 DOI: 10.1016/j.oftal.2020.05.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/10/2020] [Accepted: 05/19/2020] [Indexed: 06/11/2023]
Abstract
To describe the clinical signs and management of Descemet membrane (DM) detachment after forceps-related trauma during birth. A 2-day-old term infant presented with right eye corneal clouding and history of forceps assisted delivery. Ophthalmic assessment was consistent for corneal trauma and anterior segment optical coherence tomography (AS-OCT Visante®) revealed DM detachment. Prolonged topical treatment considerably reduced edema, but after four months of treatment superior DM detachment persisted, anterior chamber air injection at this point also failed to achieve apposition. Central visual axis remained partially spared in the months to follow, and intensive amblyopia treatment was indicated. Prolonged topical treatment may be helpful to reduce edema and risk of severe amblyopia in DM tears secondary to forceps traumatism at birth, but insufficient in cases of large DM detachment.
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Affiliation(s)
- P Diaz-Aljaro
- Departamento de Oftalmología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España.
| | - A Monés-Liivina
- Departamento de Oftalmología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | - N Romanic-Bubalo
- Departamento de Oftalmología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | - F Castillo Capponi
- Departamento de Oftalmología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | - A Sabala-Llopart
- Departamento de Oftalmología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
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Rodriguez Galarza RM, McMullen RJ. Descemet's membrane detachments, ruptures, and separations in ten adult horses: Clinical signs, diagnostics, treatment options, and preliminary results. Vet Ophthalmol 2020; 23:611-623. [PMID: 32529665 DOI: 10.1111/vop.12793] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 04/27/2020] [Accepted: 05/15/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To describe the clinical presentation, diagnostic imaging results, and treatment outcomes of a series of presumed spontaneous Descemet's membrane detachments (DMD), ruptures, or separations (DMRS) in the adult horse. ANIMALS STUDIED Ten adult horses of various breeds with DMD or DMRS. PROCEDURES Descemet's membrane detachments/DMRS were diagnosed via slit lamp biomicroscopy, ultrasound biomicroscopy (UBM), and/or optical coherence tomography (OCT). Penetrating keratoplasty (PK) with heterologous corneal donor tissue (n = 1), superficial lamellar keratectomy, and Gundersen inlay flaps alone (GF, n = 1) or with subsequent intracamerally assisted corneal tissue welding (CTW, n = 2), or CTW alone (n = 5) were performed in 9/10 horses. One horse underwent spontaneous resolution (n = 1). RESULTS Ten horses were diagnosed with either unilateral DMD (n = 4) or DMRS (n = 6). Seven of ten eyes remained visual during the follow-up period (8.16 ± 6.57 months). Graft transparency was good for the eye treated with PK. The horse that underwent GF alone was functionally blind due to persistent corneal edema. The clinical signs resolved in 3/5 horses that underwent CTW alone, but 2/5 eyes were enucleated due to corneal perforation. Both eyes treated with combined GF/CTW had significant corneal clearing with one having evidence of reattachment on UBM and OCT. CONCLUSIONS Descemet's membrane detachments separations presents differently than typical DMD and advanced corneal imaging modalities may aid in their diagnosis. Corneal tissue welding using infraCG as the photosensitive agent, or in combination with Gundersen inlay flaps, represents a feasible treatment option for management of equine DMD/DMRS as described in the present case series.
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Affiliation(s)
| | - Richard J McMullen
- JT Vaughan Large Animal Teaching Hospital, Auburn University College of Veterinary Medicine, Auburn, AL, USA
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Singhal D, Sahay P, Goel S, Asif MI, Maharana PK, Sharma N. Descemet membrane detachment. Surv Ophthalmol 2020; 65:279-293. [PMID: 31923476 DOI: 10.1016/j.survophthal.2019.12.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 12/27/2019] [Accepted: 12/30/2019] [Indexed: 10/25/2022]
Abstract
Descemet membrane detachment (DMD) is a potential vision-threatening complication that occurs most commonly after cataract surgery. DMD has also been reported to occur in various other surgeries such as keratoplasty, iridectomy, vitrectomy, trabeculectomy, holmium laser sclerostomy, alkali burn, and viscocanalostomy. Major risk factors include advanced age, preexisting endothelial diseases like Fuchs dystrophy or abnormality in the Descemet membrane and stromal interface, hard cataract, prolonged surgical time, ragged clear corneal incisions, and inadvertent trauma with blunt instruments or phacoemulsification probe. Most DMDs are peripheral and resolve spontaneously. Large, central DMDs if not managed appropriately may lead to corneal decompensation and opacification. Several authors have classified DMD depending on its configuration, height, extent, length, and position with respect to pupil. Anterior segment optical coherence tomography has been used to confirm and classify DMD and can also aid in deciding the management plan. Spontaneous reattachment of the DM with conservative management may occur in cases with small, peripheral, planar DMD with nonscrolled edges. Cases with nonplanar, central DMD, scrolled edges, and length >2 mm, however, have to be managed surgically. Descemetopexy is the gold standard for the management of DMD. Other management options include mechanical tamponade, suture fixation, descemetotomy, interface drainage, and keratoplasty. Prompt diagnosis and timely management often leads to a good visual outcome.
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Affiliation(s)
- Deepali Singhal
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Pranita Sahay
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Siddhi Goel
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Mohamed Ibrahime Asif
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Prafulla K Maharana
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Namrata Sharma
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
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Slenter IJM, Hermans H, Ensink JM, Willems DS, Veraa S, Grinwis GCM, Boevé MH. Clinical, ultrasonographic, and histopathologic findings in seven horses with Descemet's membrane detachment: A case series. Vet Ophthalmol 2019; 23:181-189. [PMID: 31544302 PMCID: PMC7003845 DOI: 10.1111/vop.12710] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 08/16/2019] [Accepted: 08/23/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To describe ultrasonography as a diagnostic method of in vivo Descemet's membrane detachment (DMD) in horses. ANIMALS STUDIED Seven horses (three Icelandic horses, two Dutch Warmblood horses, one Appaloosa, and one Welsh Pony), presenting with moderate-to-severe focal or diffuse corneal edema, in whom DMD was suspected on ultrasonographic examination and confirmed with histopathology, were studied. PROCEDURE A retrospective analysis of case records of horses with suspected DMD was performed. RESULTS Median age at presentation was 14 years (range 11-24). Clinical signs in eyes with DMD were unilateral in all horses and included blepharospasm and epiphora (6/7), buphthalmos (5/7), moderate-to-severe focal or diffuse corneal edema (7/7), corneal epithelial bullae (4/7), corneal neovascularization (4/7), Haab's striae (2/7), corneal endothelial precipitates (1/7), fibrin in the anterior chamber (1/7), focal cataract (2/7), and pigment deposits on the anterior lens capsule (1/7). During transpalpebral ultrasonography, a distinct linear echogenic structure was noted in the anterior chamber, initially diverging from, and later running parallel to, the posterior lining of the cornea in all eyes studied. In all cases, the cornea was severely thickened and echogenic, consistent with edema, and DMD was suspected. In all horses, the clinical signs progressed and the affected eye was eventually enucleated. Histopathology revealed DMD (7/7), spindle cell proliferation (4/7), Descemet's membrane reformation (3/7), and inflammation of the anterior uvea (5/7). Overall incidence was 1.04%. CONCLUSIONS Ultrasonography is an adequate tool in diagnosing DMD in horses. Descemet's membrane detachment should be included in the differential diagnosis in horses with dense focal or diffuse corneal edema.
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Affiliation(s)
- Inge J M Slenter
- Faculty of Veterinary Medicine, Department of Clinical Sciences of Companion Animals, Ophthalmology Section, Utrecht University, Utrecht, The Netherlands
| | - Hanneke Hermans
- Faculty of Veterinary Medicine, Department of Equine Sciences, Surgery Section, Utrecht University, Utrecht, The Netherlands
| | - Jos M Ensink
- Faculty of Veterinary Medicine, Department of Equine Sciences, Surgery Section, Utrecht University, Utrecht, The Netherlands
| | - Dorien S Willems
- Faculty of Veterinary Medicine Department of Clinical Sciences of Companion Animals, Diagnostic Imaging, Utrecht University, Utrecht, The Netherlands
| | - Stefanie Veraa
- Faculty of Veterinary Medicine Department of Clinical Sciences of Companion Animals, Diagnostic Imaging, Utrecht University, Utrecht, The Netherlands
| | - Guy C M Grinwis
- Faculty of Veterinary Medicine, Department of Pathobiology, Utrecht University, Utrecht, The Netherlands
| | - Michael H Boevé
- Faculty of Veterinary Medicine, Department of Clinical Sciences of Companion Animals, Ophthalmology Section, Utrecht University, Utrecht, The Netherlands
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Siwiec‐prościńska J, Szczapa‐jagustyn J, Gotz‐więckowska A, Kocięcki J. High myopic astigmatism secondary to Desçemet's membrane tears after forceps‐assisted delivery. Clin Exp Optom 2018; 101:611-612. [DOI: 10.1111/cxo.12564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/07/2017] [Accepted: 04/16/2017] [Indexed: 11/28/2022] Open
Affiliation(s)
- Joanna Siwiec‐prościńska
- Ophthalmology Institute and Clinic of Karol Marcinkowski, Poznan University of Medical Sciences, Poznan, Poland,
| | - Justyna Szczapa‐jagustyn
- Ophthalmology Institute and Clinic of Karol Marcinkowski, Poznan University of Medical Sciences, Poznan, Poland,
| | - Anna Gotz‐więckowska
- Ophthalmology Institute and Clinic of Karol Marcinkowski, Poznan University of Medical Sciences, Poznan, Poland,
| | - Jarosław Kocięcki
- Ophthalmology Institute and Clinic of Karol Marcinkowski, Poznan University of Medical Sciences, Poznan, Poland,
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