When a tractor stabs a man in the eye, who gets to write up the case report?

A journal has retracted a paper after the university notified the editors that the authors presented the gruesome details of a patient who they didn’t directly treat.

But the paper’s corresponding author disputes that claim, arguing that the first author — a radiologist, who has since passed away, provided a crucial diagnosis in this case. We’ve tried to track down the doctors who lodged a complaint about the paper, alleging they were “actually involved in the original patient treatment,” but have so far been unsuccessful.

The paper describes an unfortunate accident during which a man fell from his tractor and stabbed himself in the eye on part of the machine. Initially, doctors could not locate the eye and “believed it to have been completely destroyed,” and discharged the patient after seven days. One week later he was back, complaining of headaches — and doctors found the eye embedded deep inside the skull, intact.

According to the retraction notice, issued by the Journal of Neuro-Ophthalmology, an investigation by a university in Iran determined the doctors who initially described the case didn’t have the right to do so:

In the December 2009 issue of the Journal of Neuro-Ophthalmology, the article “Intracranial Displacement of the Eye After Blunt Trauma” appearing on page 311 is retracted. Upon the advice of the Deputy Director of Research Affairs at Tabriz University of Medical Science, Tehran, Iran the journal has decided to retract the paper on the following grounds: Following an investigation by Tabriz University, it was determined by that institution that “None of the authors of [the] paper had direct scientific or treatment link to the reported case.” The doctors actually involved in the original patient treatment brought the ethical breach to the attention of Tabriz University. Following a thorough investigation at Tabriz University it was concluded fraud through inappropriate authorship had been committed. Tabriz University as a consequence of that investigation asked the Journal of Neuro-Ophthalmology to retract the case report published in 2009.

“Intracranial Displacement of the Eye After Blunt Trauma” has been cited once since it was published in 2009, according to Clarivate Analytics’ Web of Science.

Corresponding author Nariman Nezami, previously from Department of Radiology at Tabriz University and now a resident at Yale University School of Medicine, told us that he wrote up the case report at the request of the first author, who has since passed away. According to Nezami, the first author was the radiologist who collected the images from the patient, and wanted to write a report about it. But when the ophthalmologists who physically treated the patient decided to also write a case report and saw it had already been written, they asked for it to be retracted.

Nezami told us:

Of course, we didn’t treat the patient. We are not ophthalmologists. We are radiologists. We looked at images, and we published it.

Still, he objected to the claim that the radiology team didn’t have any direct role in the patient’s care:

I’m surprised that people don’t consider radiologists as part of the team. We might not have been directly involved with the patient, but we were involved with the treatment…The fact is, we found the [eye] globe intact in the skull, and we diagnosed the patient based on that. Without that, you don’t have a case report to publish.

Here’s the description of the case:

A 67-year-old man fell accidentally from a tractor. His right eye struck a protruding part of the vehicle. He experienced massive bleeding from his right eye and a 3 to 5-minute period of unconsciousness. Eight hours later, he was brought to the emergency unit of an ophthalmology hospital where examiners could not find the right eye and believed it to have been completely destroyed. The orbit was irrigated and an upper eyelid laceration was repaired.

Throughout 7 days of hospitalization and 7 days of partial bed rest at home, the patient complained of severe right frontal headache. CT (Fig. 1) revealed that the right eye appeared to be intact and had herniated through a bony defect in the right orbit roof and substantially into the floor of the anterior fossa.

As far as we know, there have been no case reports demonstrating trauma-induced intracranial dislocation of an intact eye.

(The report doesn’t say if the physicians were able to put the eyeball back in place.)

Jason Roberts, managing editor of the Journal of Neuro-ophthalmology, told us it was the journal’s first retraction:

Briefly, Tabriz University contacted us to complain about a paper we had published several years ago (actually before anyone currently associated with the journal worked on the title). Essentially, the physicians who had originally treated the patient recognized their patient in the article we had published and were surprised to find people unconnected to the case had written it up. The treating physicians complained to Tabriz University in Iran in September 2015. They, in turn, opened an investigation…Tabriz contacted the original authors of the paper. It appears the lead author on the paper had died in the intervening time and the co-authors of the paper all pointed a finger at the deceased author in the sense that they said this particular individual had developed the case report by holding the data…

He concluded:

Our dilemma was whether or not to take the serious step of retracting the paper. It was determined that the authors had committed fraud and as a consequence the information revealed in the case report could not be trusted or indeed verified, even if they had simply written up detailed case notes provided by another physician. Neuro-Ophthalmology, unlike a lot of biomedical fields, is not rich in randomized controlled trials and other large scale studies. It is still quite case-based driven. Consequently, as one of only two journals in the field, the stakes are much higher when we publish a case report. it is not a small, throwaway, article but perhaps something that could influence practice. it is regrettable that we had to retract the paper and I hope its not something we will be compelled to do again in the future…

We asked Roberts for the names and affiliations of the ophthalmologists who asked to retract the paper; he referred us to Tabriz University. We’ve contacted the university repeatedly, but have not heard anything back.

Like Retraction Watch? Consider making a tax-deductible contribution to support our growth. You can also follow us on Twitter, like us on Facebook, add us to your RSS reader, sign up on our homepage for an email every time there’s a new post, or subscribe to our new daily digest. Click here to review our Comments Policy. For a sneak peek at what we’re working on, click here.