Thomas A. Swift's Electric Rifle Injuries to the Eye and Ocular Adnexa: The Management of Complex Trauma

Stavros N. Moysidis, Nicole Koulisis, Damien C. Rodger, Jennifer R. Chao, Theodore Leng, Talisa de Carlo, Bruce Burkemper, Lilangi S. Ediriwickrema, Meena S. George, Yi Jiang, Kelley J. Bohm, Shilpa Gulati, Rodrigo J. Torres, Mario A. Meallet, Andrew A. Moshfeghi, Harry W Flynn, William F. Mieler, George A. Williams, Mark S. Humayun, Dean Eliott

Research output: Contribution to journalArticle

Abstract

Purpose: To report the ocular and adnexal injuries sustained by patients with Thomas A. Swift's electric rifles (TASER; TASER International, Scottsdale, AZ), review the literature, and discuss the management of this complex trauma. Design: Multicenter, retrospective case series and literature review. Participants: Seventeen eyes of 16 patients (5 eyes of 5 patients treated at 3 institutions, and 12 eyes of 11 previously reported cases). Methods: The clinical data of 17 eyes were pooled. Spearman's correlation coefficient was used to assess the association between the extent of TASER injury and patient outcomes. Main Outcome Measures: Extent of TASER injury (zone of injury, penetrating vs. perforating) and association with patient outcomes (visual acuity [VA] and retinal detachment [RD]). Results: In our cohort, 4 patients were transported by law enforcement and 1 was transferred from a community hospital. Four patients were taken to the operating room for TASER removal and globe repair; 1 patient underwent removal in the emergency room. Of 17 pooled cases, 12 (71%) involved open-globe injury. Of these, there was a high rate of zone 3 injuries (100%; n = 12) and a high incidence of RD (73%; 8 of 11, eviscerated eye excluded). Among patients with closed-globe injury (n = 5), 1 patient demonstrated exudative RD and 1 patient demonstrated retinal dialysis with RD. Of 10 patients with RD, 1 (10%) achieved resolution with monitoring (exudative RD); 1 (10%) underwent cryopexy and pneumatic retinopexy; 3 (30%) underwent vitrectomy, and 5 (50%) with poor prognosis did not undergo vitreoretinal surgery. In the 3 patients who underwent vitrectomy, all 3 (100%) demonstrated redetachment resulting from proliferative vitreoretinopathy and required additional surgery. Visual acuity on presentation was significantly correlated with final VA (ρ = 0.783; P = 0.02). Men (94%) were more likely than women (6%) to sustain TASER trauma. Median age was 26 years. There was a 50% rate of loss to follow-up. Conclusions: Thomas A. Swift's electric rifle injuries to the eyes or ocular adnexa represent complex trauma. Zone 3 injuries are common. The visual prognosis is guarded, and eyes may require multiple surgeries to preserve vision. Patients are at high risk for loss to follow-up by way of incarceration.

Original languageEnglish (US)
Pages (from-to)258-269
Number of pages12
JournalOphthalmology Retina
Volume3
Issue number3
DOIs
StatePublished - Mar 1 2019

Fingerprint

Electric Injuries
Firearms
Wounds and Injuries
Retinal Detachment
Conducted Energy Weapon Injuries
Visual Acuity
Vitrectomy
Vitreoretinal Surgery
Proliferative Vitreoretinopathy
Eye Injuries
Law Enforcement

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Moysidis, S. N., Koulisis, N., Rodger, D. C., Chao, J. R., Leng, T., de Carlo, T., ... Eliott, D. (2019). Thomas A. Swift's Electric Rifle Injuries to the Eye and Ocular Adnexa: The Management of Complex Trauma. Ophthalmology Retina, 3(3), 258-269. https://doi.org/10.1016/j.oret.2018.10.005

Thomas A. Swift's Electric Rifle Injuries to the Eye and Ocular Adnexa : The Management of Complex Trauma. / Moysidis, Stavros N.; Koulisis, Nicole; Rodger, Damien C.; Chao, Jennifer R.; Leng, Theodore; de Carlo, Talisa; Burkemper, Bruce; Ediriwickrema, Lilangi S.; George, Meena S.; Jiang, Yi; Bohm, Kelley J.; Gulati, Shilpa; Torres, Rodrigo J.; Meallet, Mario A.; Moshfeghi, Andrew A.; Flynn, Harry W; Mieler, William F.; Williams, George A.; Humayun, Mark S.; Eliott, Dean.

In: Ophthalmology Retina, Vol. 3, No. 3, 01.03.2019, p. 258-269.

Research output: Contribution to journalArticle

Moysidis, SN, Koulisis, N, Rodger, DC, Chao, JR, Leng, T, de Carlo, T, Burkemper, B, Ediriwickrema, LS, George, MS, Jiang, Y, Bohm, KJ, Gulati, S, Torres, RJ, Meallet, MA, Moshfeghi, AA, Flynn, HW, Mieler, WF, Williams, GA, Humayun, MS & Eliott, D 2019, 'Thomas A. Swift's Electric Rifle Injuries to the Eye and Ocular Adnexa: The Management of Complex Trauma', Ophthalmology Retina, vol. 3, no. 3, pp. 258-269. https://doi.org/10.1016/j.oret.2018.10.005
Moysidis, Stavros N. ; Koulisis, Nicole ; Rodger, Damien C. ; Chao, Jennifer R. ; Leng, Theodore ; de Carlo, Talisa ; Burkemper, Bruce ; Ediriwickrema, Lilangi S. ; George, Meena S. ; Jiang, Yi ; Bohm, Kelley J. ; Gulati, Shilpa ; Torres, Rodrigo J. ; Meallet, Mario A. ; Moshfeghi, Andrew A. ; Flynn, Harry W ; Mieler, William F. ; Williams, George A. ; Humayun, Mark S. ; Eliott, Dean. / Thomas A. Swift's Electric Rifle Injuries to the Eye and Ocular Adnexa : The Management of Complex Trauma. In: Ophthalmology Retina. 2019 ; Vol. 3, No. 3. pp. 258-269.
@article{10820814a67444e39dc316cb6a36d27a,
title = "Thomas A. Swift's Electric Rifle Injuries to the Eye and Ocular Adnexa: The Management of Complex Trauma",
abstract = "Purpose: To report the ocular and adnexal injuries sustained by patients with Thomas A. Swift's electric rifles (TASER; TASER International, Scottsdale, AZ), review the literature, and discuss the management of this complex trauma. Design: Multicenter, retrospective case series and literature review. Participants: Seventeen eyes of 16 patients (5 eyes of 5 patients treated at 3 institutions, and 12 eyes of 11 previously reported cases). Methods: The clinical data of 17 eyes were pooled. Spearman's correlation coefficient was used to assess the association between the extent of TASER injury and patient outcomes. Main Outcome Measures: Extent of TASER injury (zone of injury, penetrating vs. perforating) and association with patient outcomes (visual acuity [VA] and retinal detachment [RD]). Results: In our cohort, 4 patients were transported by law enforcement and 1 was transferred from a community hospital. Four patients were taken to the operating room for TASER removal and globe repair; 1 patient underwent removal in the emergency room. Of 17 pooled cases, 12 (71{\%}) involved open-globe injury. Of these, there was a high rate of zone 3 injuries (100{\%}; n = 12) and a high incidence of RD (73{\%}; 8 of 11, eviscerated eye excluded). Among patients with closed-globe injury (n = 5), 1 patient demonstrated exudative RD and 1 patient demonstrated retinal dialysis with RD. Of 10 patients with RD, 1 (10{\%}) achieved resolution with monitoring (exudative RD); 1 (10{\%}) underwent cryopexy and pneumatic retinopexy; 3 (30{\%}) underwent vitrectomy, and 5 (50{\%}) with poor prognosis did not undergo vitreoretinal surgery. In the 3 patients who underwent vitrectomy, all 3 (100{\%}) demonstrated redetachment resulting from proliferative vitreoretinopathy and required additional surgery. Visual acuity on presentation was significantly correlated with final VA (ρ = 0.783; P = 0.02). Men (94{\%}) were more likely than women (6{\%}) to sustain TASER trauma. Median age was 26 years. There was a 50{\%} rate of loss to follow-up. Conclusions: Thomas A. Swift's electric rifle injuries to the eyes or ocular adnexa represent complex trauma. Zone 3 injuries are common. The visual prognosis is guarded, and eyes may require multiple surgeries to preserve vision. Patients are at high risk for loss to follow-up by way of incarceration.",
author = "Moysidis, {Stavros N.} and Nicole Koulisis and Rodger, {Damien C.} and Chao, {Jennifer R.} and Theodore Leng and {de Carlo}, Talisa and Bruce Burkemper and Ediriwickrema, {Lilangi S.} and George, {Meena S.} and Yi Jiang and Bohm, {Kelley J.} and Shilpa Gulati and Torres, {Rodrigo J.} and Meallet, {Mario A.} and Moshfeghi, {Andrew A.} and Flynn, {Harry W} and Mieler, {William F.} and Williams, {George A.} and Humayun, {Mark S.} and Dean Eliott",
year = "2019",
month = "3",
day = "1",
doi = "10.1016/j.oret.2018.10.005",
language = "English (US)",
volume = "3",
pages = "258--269",
journal = "Ophthalmology Retina",
issn = "2468-7219",
publisher = "Elsevier Inc.",
number = "3",

}

TY - JOUR

T1 - Thomas A. Swift's Electric Rifle Injuries to the Eye and Ocular Adnexa

T2 - The Management of Complex Trauma

AU - Moysidis, Stavros N.

AU - Koulisis, Nicole

AU - Rodger, Damien C.

AU - Chao, Jennifer R.

AU - Leng, Theodore

AU - de Carlo, Talisa

AU - Burkemper, Bruce

AU - Ediriwickrema, Lilangi S.

AU - George, Meena S.

AU - Jiang, Yi

AU - Bohm, Kelley J.

AU - Gulati, Shilpa

AU - Torres, Rodrigo J.

AU - Meallet, Mario A.

AU - Moshfeghi, Andrew A.

AU - Flynn, Harry W

AU - Mieler, William F.

AU - Williams, George A.

AU - Humayun, Mark S.

AU - Eliott, Dean

PY - 2019/3/1

Y1 - 2019/3/1

N2 - Purpose: To report the ocular and adnexal injuries sustained by patients with Thomas A. Swift's electric rifles (TASER; TASER International, Scottsdale, AZ), review the literature, and discuss the management of this complex trauma. Design: Multicenter, retrospective case series and literature review. Participants: Seventeen eyes of 16 patients (5 eyes of 5 patients treated at 3 institutions, and 12 eyes of 11 previously reported cases). Methods: The clinical data of 17 eyes were pooled. Spearman's correlation coefficient was used to assess the association between the extent of TASER injury and patient outcomes. Main Outcome Measures: Extent of TASER injury (zone of injury, penetrating vs. perforating) and association with patient outcomes (visual acuity [VA] and retinal detachment [RD]). Results: In our cohort, 4 patients were transported by law enforcement and 1 was transferred from a community hospital. Four patients were taken to the operating room for TASER removal and globe repair; 1 patient underwent removal in the emergency room. Of 17 pooled cases, 12 (71%) involved open-globe injury. Of these, there was a high rate of zone 3 injuries (100%; n = 12) and a high incidence of RD (73%; 8 of 11, eviscerated eye excluded). Among patients with closed-globe injury (n = 5), 1 patient demonstrated exudative RD and 1 patient demonstrated retinal dialysis with RD. Of 10 patients with RD, 1 (10%) achieved resolution with monitoring (exudative RD); 1 (10%) underwent cryopexy and pneumatic retinopexy; 3 (30%) underwent vitrectomy, and 5 (50%) with poor prognosis did not undergo vitreoretinal surgery. In the 3 patients who underwent vitrectomy, all 3 (100%) demonstrated redetachment resulting from proliferative vitreoretinopathy and required additional surgery. Visual acuity on presentation was significantly correlated with final VA (ρ = 0.783; P = 0.02). Men (94%) were more likely than women (6%) to sustain TASER trauma. Median age was 26 years. There was a 50% rate of loss to follow-up. Conclusions: Thomas A. Swift's electric rifle injuries to the eyes or ocular adnexa represent complex trauma. Zone 3 injuries are common. The visual prognosis is guarded, and eyes may require multiple surgeries to preserve vision. Patients are at high risk for loss to follow-up by way of incarceration.

AB - Purpose: To report the ocular and adnexal injuries sustained by patients with Thomas A. Swift's electric rifles (TASER; TASER International, Scottsdale, AZ), review the literature, and discuss the management of this complex trauma. Design: Multicenter, retrospective case series and literature review. Participants: Seventeen eyes of 16 patients (5 eyes of 5 patients treated at 3 institutions, and 12 eyes of 11 previously reported cases). Methods: The clinical data of 17 eyes were pooled. Spearman's correlation coefficient was used to assess the association between the extent of TASER injury and patient outcomes. Main Outcome Measures: Extent of TASER injury (zone of injury, penetrating vs. perforating) and association with patient outcomes (visual acuity [VA] and retinal detachment [RD]). Results: In our cohort, 4 patients were transported by law enforcement and 1 was transferred from a community hospital. Four patients were taken to the operating room for TASER removal and globe repair; 1 patient underwent removal in the emergency room. Of 17 pooled cases, 12 (71%) involved open-globe injury. Of these, there was a high rate of zone 3 injuries (100%; n = 12) and a high incidence of RD (73%; 8 of 11, eviscerated eye excluded). Among patients with closed-globe injury (n = 5), 1 patient demonstrated exudative RD and 1 patient demonstrated retinal dialysis with RD. Of 10 patients with RD, 1 (10%) achieved resolution with monitoring (exudative RD); 1 (10%) underwent cryopexy and pneumatic retinopexy; 3 (30%) underwent vitrectomy, and 5 (50%) with poor prognosis did not undergo vitreoretinal surgery. In the 3 patients who underwent vitrectomy, all 3 (100%) demonstrated redetachment resulting from proliferative vitreoretinopathy and required additional surgery. Visual acuity on presentation was significantly correlated with final VA (ρ = 0.783; P = 0.02). Men (94%) were more likely than women (6%) to sustain TASER trauma. Median age was 26 years. There was a 50% rate of loss to follow-up. Conclusions: Thomas A. Swift's electric rifle injuries to the eyes or ocular adnexa represent complex trauma. Zone 3 injuries are common. The visual prognosis is guarded, and eyes may require multiple surgeries to preserve vision. Patients are at high risk for loss to follow-up by way of incarceration.

UR - http://www.scopus.com/inward/record.url?scp=85070435267&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85070435267&partnerID=8YFLogxK

U2 - 10.1016/j.oret.2018.10.005

DO - 10.1016/j.oret.2018.10.005

M3 - Article

AN - SCOPUS:85070435267

VL - 3

SP - 258

EP - 269

JO - Ophthalmology Retina

JF - Ophthalmology Retina

SN - 2468-7219

IS - 3

ER -