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 Jr; William F Mieler; George A Williams; Mark S Humayun; Dean Eliott

doi: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

Ophthalmol Retina. 2019 Mar;3(3):258-269. doi: 10.1016/j.oret.2018.10.005. Epub 2018 Oct 10.

Authors

Stavros N Moysidis¹, Nicole Koulisis², Damien C Rodger², Jennifer R Chao³, Theodore Leng⁴, Talisa de Carlo⁵, Bruce Burkemper⁶, Lilangi S Ediriwickrema², Meena S George², Yi Jiang⁵, Kelley J Bohm⁵, Shilpa Gulati⁵, Rodrigo J Torres², Mario A Meallet², Andrew A Moshfeghi², Harry W Flynn Jr⁷, William F Mieler⁵, George A Williams⁸, Mark S Humayun⁹, Dean Eliott¹⁰

Affiliations

¹ USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California; Department of Ophthalmology, Los Angeles County + University of Southern California Medical Center, Los Angeles County Medical Center, University of Southern California, Los Angeles, California; Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan.
² USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California; Department of Ophthalmology, Los Angeles County + University of Southern California Medical Center, Los Angeles County Medical Center, University of Southern California, Los Angeles, California.
³ Department of Ophthalmology, University of Washington, Seattle, Washington.
⁴ Byers Eye Institute at Stanford, Stanford University School of Medicine, Palo Alto, California.
⁵ Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois, Chicago, Illinois.
⁶ USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California.
⁷ Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
⁸ Associated Retinal Consultants, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan.
⁹ USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California; Department of Ophthalmology, Los Angeles County + University of Southern California Medical Center, Los Angeles County Medical Center, University of Southern California, Los Angeles, California; USC Institute for Biomedical Therapeutics, University of Southern California, Los Angeles, California.
¹⁰ Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts. Electronic address: dean_eliott@meei.harvard.edu.

PMID: 31014704
DOI: 10.1016/j.oret.2018.10.005

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.

Publication types

Case Reports
Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Electric Injuries / surgery*
Eye Foreign Bodies / surgery
Eye Injuries, Penetrating / surgery*
Firearms*
Humans
Male
Middle Aged
Retina / injuries*
Retrospective Studies
Vitrectomy
Vitreoretinal Surgery
Young Adult