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M. E. Andreoli, C. Westerfeld, M. T. Andreoli, C. Kloek, C. M. Andreoli; Nail Related Open Globe Injuries. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5487.
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There is a paucity in the literature regarding the epidemiology and outcomes of nail related open globe injuries, despite their relative frequency. Here we review a large series of nail related open globe injuries in order to identify prognostic factors and outcomes that will help manage these patients.
The charts of 648 consecutive patients with open globe injuries presenting to a major eye trauma center were reviewed with attention given to the age of the patient, gender, mechanism, location of trauma event, presence of an intraocular foreign body (IOFB), and presenting and post-operative visual acuity.
Of the 648 consecutive open globe patients reviewed, 80 patients were found to have nail induced open globe injuries (12.3%). This was the fourth most common mechanism recorded following other projectiles (20%), blunt trauma (16.8%) and falls (14%). Patient age ranged from 1 year to age 67 years with a mean of 34. Injuries occurred in male patients in 79 out of 80 cases (98.8%). In cases where the location of the trauma was documented, 23 out of 39 occurred at work (60.0%). The average follow-up was 266 days.Best post-operative visual acuity was LP in 2 cases (2.5%), HM or CF in 8 cases (10%), ≥ 20/200 in 68 cases (85.0%), and ≥ 20/40 in 56 cases (70.0%). These results were better than the overall population of open globe injuries. Final visual acuity was improved from presenting acuity in 70 cases (87.5%), remained the same in 3 cases, and declined in only 4 cases (5.0%).An IOFB (i.e. nail) was documented at the time of presentation in 11 out of 80 cases (13.8%). The patients with an IOFB on presentation had similar final visual acuities to those without IOFBs.On surgical repair, 51 were founds to have a laceration in Zone I, 18 Zone II, and14 in Zone III. Post-injury complications included 12 (15%) patients who developed and intraocular pressure of greater than 25 during at least one postoperative visit and 8 (10%) patients with retinal detachments. Eighteen (13%) patients required lensectomy during original repair and 24 (30%) more developed a cataract in follow-up. No patient with nail related injury developed phthisis or required enucleation during the study period.
Nail related open globe injuries occur with relatively high frequency. The vast majority of these injuries occur in young men while they are at work. Surgical repair typically results in equal or improved final visual outcome in the vast majority of cases. There is a very high rate of lens damage in these patients and moderate rate of retinal detachment.
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