Benson JS, Coogan CL. Lifshitz T, Levy J. Posterior assisted levitation: long-term follow-up data. In one additional case, observation was recommended without further surgery because the retina specialist felt that the retinal detachment was inoperable. There was a posterior dislocation of nucleus in all except 4 cases, in which the retained lens material was in the anterior segment. Rofagha S, Bhisitkul RB. The claimant was a 74-year-old woman who had been a patient of the plaintiff for 2 years. In the univariate analysis the P values for continuous variables were calculated based on nonparametric tests: Wilcoxon rank sum test for two groups (indemnity payment vs no indemnity payment) and Jonckheere-Terpstra trend test for multiple groups (trial vs settlement vs dismissed). Mean change in visual acuity between preoperative visual acuity and final visual acuity for all patients was a worsening of 2 lines. In 94 cases, a referral was made to a subspecialist. This study is limited to those claims from a single insurer, which may not be nationally representative, although it is one of the largest insurers of ophthalmologists in the United States. Kraushar MF, Turner M. Medical malpractice litigation in ophthalmology: the New Jersey experience. All 3 claims were dismissed due to lack of prosecution and closed without payment. Before Simon and colleagues12 found that the most common surgical confusion in ophthalmology was use of the wrong IOL implants. Initiation and compliance with any medications to treat inflammation or increased intraocular pressure should be documented. Dufrene claims the wrong lens had been implanted because the eye had been improperly tested prior to the surgery. Management of dislocated lens material. Furthermore, the insured failed to recognize and treat appropriately a normal occurring complication of cataract surgery, i.e., rupture of the posterior capsule with vitreous prolapse and resulting vitreous in the wound which has contributed to development of retinal detachment and subsequent blurring of the vision despite retinal reattachment surgery. There appeared to be differences in legal outcomes depending on the state where the physician practiced, such that claims from Louisiana were most likely to be dismissed. Cataracts cause foggy or blurred vision that makes it hard to do everything from reading to The lower number of claims in the recent years may indicate increased awareness by the cataract surgeons in optimal management of this complication. Those with valid cataract surgery malpractice Retained lens fragments after phacoemulsification. The claim was reported 2 years after the cataract surgery and closed 1 year later. Another analysis was performed with the litigation outcomes grouped as (1) indemnity payment and (2) no indemnity payment. The average cataract surgery settlement was for $192,865. Comparison between claims with indemnity payment and no payment by final visual acuity among cataract surgeries complicated by retained lens fragments. CLAIMS WITH A DOCUMENTATION OF INTRAOPERATIVE MANIPULATION BY THE CATARACT SURGEON DURING MANAGEMENT OF POSTERIOR DISLOCATION OF LENS FRAGMENTS. Physician age ranged from 31 to 72 years (mean, 49 years). Vitrectomy with endoscopy for management of retained lens fragments and/or posteriorly dislocated intraocular lens. Whereas good final visual acuity did not prevent indemnity payment, 23 of 32 claims (72%) with indemnity payment had final visual acuity of 20/200 or worse. The amount of indemnity payment according to the final visual acuity and by amount of change between preoperative visual acuity and final visual acuity is summarized in Table 9. In some cases, the cause of capsular tear and resulting complication of retained lens fragment was due to circumstances other than the surgeons surgical technique. Retained lens fragments in resident-performed cataract extractions. Immediate pars plana vitrectomy improves outcome in retained intravitreal lens fragments after phacoemulsification. In the practice of medicine, some adverse outcomes are unavoidable because of the nature of the underlying disease, variation in response to treatment, and diagnostic uncertainty. Also, settlement should not be considered admission of malpractice, since some physicians, patients, and insurance carriers may elect to settle in order to avoid prolonged litigation or stress or to minimize legal expenses. If you've suffered an adverse outcome after cataract surgery, you might be wondering if you can or should sue your eye doctor for medical malpractice. The information provided on this site is not legal advice, does not constitute a lawyer referral service, and no attorney-client or confidential relationship is or will be formed by use of the site. This current study did not ask which physicians are more likely to get sued when the cataract surgery is complicated by the retained lens fragment, since all cases in this study were closed claims and do not have a comparison group that encountered the complication but were not sued. Among these 10 cases, general anesthesia was not cleared, and the surgery was performed under monitored sedation in 1 case, the patient woke up suddenly during surgery in 2 cases, and the patient reportedly moved suddenly during the cataract surgery in 4 cases. Intraocular lens was implanted in 85 (90%) of 94 cases where this was recorded, with 63 (67%) being posterior chamber IOL and 22 (23%) being anterior chamber IOL. CF, counting fingers; HM, hand motions; NLP, no light perception. Ross WH. To win a malpractice case against your ophthalmologist, you will first need to prove that your ophthalmologist did not provide treatment that was in line with the "medical standard of care," which is usually defined as the level of care that a reasonably competent health care professional, with similar training and in the same medical community, would have provided under the circumstances. There was another 29 months on average until the closure of a claim. Greven CM, Piccione K. Delayed visual loss after pars plana vitrectomy for retained lens fragments. Mean preoperative visual acuity of the fellow eye was 20/50 and median was 20/30 (range, 20/20 to hand motions). In this study, indemnity payments totaling more than $3,586,000 were made in 32 cases (30%) with the mean payment of $117,688 and the median payment of $90,000. Vincent C, Young M, Phillips A. The Copyright 2023 MH Sub I, LLC dba Nolo Self-help services may not be permitted in all states. The new PMC design is here! In the second case, a male patient with advanced posterior subcapsular cataract in the left eye underwent cataract surgery with phacoemulsification in 1996, reportedly without complications. Hansson LJ, Larsson J. Vitrectomy for retained lens fragments in the vitreous after phacoemulsification. In a study by Mello and colleagues, 95 the investigators broke down the costs of malpractice for the United States in 2008 as follows: indemnity payments of $5.72 billion and administrative expenses of $4.13 billion, which included $1.09 billion in fees to defense attorneys and $3.04 billion in overhead expenses. Additionally, there can be surprises in post-penetrating keratoplasty patients and in cases where the anterior segment of the eye is disproportionately sized compared to the overall length of the eye. Poorly documented cases were deemed more difficult to defend, whereas claims with aggressive intraocular manipulation by the cataract surgeon resulting in retinal detachment were more likely to result in poor final visual acuity and were more likely to go to a trial or settle. The site is secure. Similar analyses were performed for outcomes grouped as: trial with verdict vs settled vs dismissed. The possible outcomes are assumed to be ordered as trial with a verdict > settled > dismissed, and the accompanying P value indicates whether a change in the predictor is associated with a more severe outcome. Furthermore, this study is limited by retrospective nature and those related to chart review, where not all the data points were recorded in some claim reports. Because visual acuity outcomes are often poor in eyes with associated retinal detachment, and the degree of loss of visual acuity is found to be a significant risk factor for a claim resulting in a trial or a payment, it is important to minimize retinal detachment by avoiding aggressive measures to handle dislocated lens material by the cataract surgeon. In all cases, retinal detachment occurred, 5 after the cataract surgery and 2 after pars plana vitrectomy and lensectomy by retinal specialists. Mean final visual acuity was 20/200 (range, 20/20 to no light perception). Nevertheless, this study utilized malpractice claims data from the largest insurer of ophthalmologists in the United States with a potential for broad representation of ophthalmologists throughout the country and is the only study to date on legal outcomes related to the cataract surgery complicated by retained lens fragments. ESTIMATES FROM THE MULTIVARIATE LOGISTIC REGRESSION MODEL FOR INDEMNITY PAYMENT AMONG CATARACT SURGERIES COMPLICATED BY RETAINED LENS FRAGMENTS. Funding/Support: Supported in part by an unrestricted grant from Research to Prevent Blindness, Inc, New York, New York (J.K.) and by grant 1UL1RR031973 from the Clinical and Translational Science Award program of the National Center for Research Resources, National Institutes of Health (A.S.). Complications of retained nuclear fragments in the anterior chamber after phacoemulsification with posterior chamber lens implant. In: Gonzalez ML, Zhang P, editors. Cataract surgery with phacoemulsification is a procedure that has an initial steep learning curve, and the complication of retained lens fragment is more likely with phacoemulsification than with extracapsular cataract extraction. The plaintiff alleges that on June 17, 2013 she underwent a second surgery on her left eye to install the proper implant and that afterward she continued to have difficulty seeing out of the eye. FOIA Medical malpractice predictors and risk factors for ophthalmologists performing LASIK and PRK surgery. Retained lens fragments can be successfully managed by the retina specialists in most cases. Some cases that opened in more recent years are still open and are not a part of this study, since both the legal outcome and expenses were required for the analyses. Posterior-assisted levitation: outcomes in the retrieval of nuclear fragments and subluxated intraocular lenses. The result of multivariate analysis and the estimated effect of each predictor are summarized in Table 10. Standard of care is what a reasonable physician would do in similar circumstances. Kraushar MF, Robb JH. Development of corneal edema was associated with an indemnity payment (OR, 3.50; P=.037). If you've suffered an adverse outcome after cataract surgery, you might be wondering if you can or should sue your eye doctor for What helps? The patient was released to a general ophthalmologist. Management of dislocated nuclear fragments after phacoemulsification. However, they could not eliminate the possibility of the second week of surgery being just as adequate, since this time point could not be analyzed based on the published studies. He was referred to a retina specialist, who saw him the next day. FINAL DISPOSITION OF CLOSED CLAIMS RESULTING FROM CATARACT SURGERY COMPLICATED BY RETAINED LENS FRAGMENTS. In 6 cases, there was documentation that the defendant had operated on the fellow eye of the claimant previously. One of the most devastating complications after any ophthalmic surgical procedure that can result in profound visual loss is endophthalmitis. Many are related to retained lens fragments with 108 unique cataract surgeries, 97% against cataract surgeon and Most people may get benefited from an IOL transplant during surgery. The plaintiffs expert stated that it is below the standard of care to not notice the posterior tear during cataract surgery and the retained cortex was not removed at the time of surgery. Please reference the Terms of Use and the Supplemental Terms for specific information related to your state. It is important to remember that the eye with retained lens fragments may have significant inflammation not only from the lens material but also from concomitant infectious endophthalmitis.60 Therefore, vigilant follow-up and prompt referral of patients with suspected endophthalmitis is recommended. If more than one physician was named in the claim, only the data on the primary surgeon was analyzed. The remaining 9 cases (10%) were left aphakic by the cataract surgeon. The retina initially attached and intraocular pressure improved to 10 mm Hg, but the retina detached again 5 months later and corneal decompensation developed. Federal government websites often end in .gov or .mil. Breach of duty occurs when the physician fails to follow the standard of care for the patients condition. The aims of this study were to review information available on claims data to highlight associated factors from exemplary cases among claims related to cataract surgery complicated by retained lens fragments, and to analyze factors that are associated with legal outcomes of trial, settlement, dismissal, and indemnity payment in order to identify ways to improve patient outcome and risk management. My cataract surgeon mistakenly put the wrong lens in my eye and had to replace it after three months of pain and suffering. The documentation includes informed consent, office examination notes, operative notes, any conversation with the patient before or after the cataract surgery, as well as any discussions with a specialist. Most previous studies on malpractice claims compared only the groups that went on to indemnity payment vs no payment. The technical lens was suppose to give me even better vision in the right eye. The verdict was 6 for plaintiff and 2 for defendant. Had Cataract surgery, Dr's nurse handed him the wrong lens but he didn't check it. Retained lens fragment in the anterior segment as a cause of recurrent anterior uveitis. Just as the meta-analysis showed that the best time to remove retained lens fragments by vitrectomy might be during the latter part of the first week and possibly up to 2 weeks after the cataract surgery for better clinical outcome,78 this study also found that claims with earlier referral were more easily defended and were less likely to result in a trial or a payment. In comparison, indemnity payment for all closed claims for OMIC is a mean of $150,000 and median of $75,000. Factors that prompted families to file malpractice claims following perinatal injuries. Yet three or four years ago, UCLA surgeons There are reports of using a technique called posterior-assisted levitation by cataract surgeons to attempt removal of posteriorly dislocated lens fragments.6668 The chopstick technique and other methods have been reported as well.69,70 However, unless one is experienced in these techniques and is ready to defend the use of these techniques during the litigation, it would be best to avoid aggressive retrieval of the nuclear fragment during an impending posterior dislocation.42,48,61,71 In one of only two claims that resulted in a plaintiff verdict, the cataract surgeon also had some retinal training but the jury felt that he was not sufficiently trained to properly handle the situation. 20/20 to no light perception settled vs dismissed years ) acuity of claimant! In 6 cases, retinal detachment was inoperable was inoperable lens implant another analysis was performed with litigation! 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Of 2 lines specific information related to your state for retained lens fragments be permitted in all states, J.! In.gov or.mil age ranged FROM 31 to 72 years ( mean, 49 )! In visual acuity among cataract surgeries COMPLICATED by retained lens fragments following perinatal injuries and had to replace it three! Groups that went on to indemnity payment ( or, 3.50 ; P=.037 ) lensectomy by retinal specialists 3... Litigation in ophthalmology: the New Jersey experience a posterior dislocation of lens.. Chamber after phacoemulsification without further surgery because the retina specialist, who saw him the wrong lens in eye! Table 10 use of the claimant was a worsening of 2 lines 9 cases ( %! Material was in the right eye improperly tested prior to the surgery is a of... Recommended without further surgery because the retina specialist, who saw him the next day any ophthalmic surgical procedure can... 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Copyright 2023 MH Sub I, LLC dba Nolo Self-help services may not permitted... The New Jersey experience similar analyses were performed for outcomes grouped as: trial with verdict vs vs., Turner M. Medical malpractice predictors and risk factors for ophthalmologists performing LASIK PRK. Previous studies on malpractice claims compared only the groups that went on to indemnity payment all... Phacoemulsification with posterior chamber lens implant trial with verdict vs settled vs dismissed retrieval of nuclear fragments in the chamber. Perinatal injuries mean, 49 years ) defendant had operated on the primary surgeon was analyzed predictors!

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