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Avni Shah, Alain Bauza, Anton Kolomeyer, Paul Langer, Marco Zarbin, Neelakshi Bhagat; Nail Gun-Induced Open Globe Injuries: A Ten-Year Retrospective Review. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4439.
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© ARVO (1962-2015); The Authors (2016-present)
To describe the epidemiology, clinical presentation, management, and complications of open globe injuries (OGI) resulting from nail gun accidents.
A retrospective review of all patients who presented to University Hospital at Newark, NJ, between 2000 and 2010 with open globes secondary to nail gun injury was conducted. Data were collected on demographics, setting of accident, presenting clinical exam findings, inpatient management, surgical procedures needed, and long-term outcomes. Final visual acuity (VA) of patients with at least three months of follow-up was compared to presenting VA.
Forty-three eyes of 42 patients (7.1% of all open globes, n=604) suffered OGI from nail gun accidents. All patients were male; mean presenting age was 31.6 years. Most patients (88%) were Hispanic. 86% of accidents were work-related. Mechanism of injury included ricochet, gun jamming, and backfiring. All injuries were classified as penetrating or intraocular foreign body (IOFB). Entrance wounds were classified into zone I (n=24 [56%]), zone II (n=12 [28%]), and zone III (n=7 [16%]). Mean presenting VA was 1.64 logMAR (Snellen VA 20/873). 40% of eyes developed traumatic cataracts and 28% developed retinal detachments (RD). Posterior segment complications were present in 77% of cases. Six eyes (14%) had retained IOFBs. All eyes underwent primary closure without primary enucleation. 23 eyes (53%) required a mean of 1.5 reoperations. Of these, 14 (61%) underwent pars plana vitrectomy for non-resolving vitreous hemorrhage and/or RD. Average duration of follow up was 14 months. At last visit, mean VA was 1.02 logMAR (Snellen VA 20/211). 84% of eyes had improved or stable vision compared to presentation. Only 47% of eyes had a final VA of 20/40 or better (n=32). No eyes developed endophthalmitis. Three (7%) eyes were phthisical or pre-phthisical, with one secondarily enucleated due to phthisis and no light perception VA.
To our knowledge, this is the largest compilation of nail gun-related OGI reported thus far. Posterior segment complications were noted in over three-fourths of cases, likely contributing to the overall guarded visual outcomes. Preventative measures for eye protection should be strictly followed while using nail guns.
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