Lu H, Jiang YR, Grabow HB. Most cases of elevated intraocular pressure can be managed with medication or be resolved with pars plana vitrectomy.2024,2834,50,51 However, there were claimants in this study who required glaucoma surgeries to lower intraocular pressure and others who had suffered permanent visual field loss despite improved visual acuity. My vision actually was worse after the lens placement. Posterior-assisted levitation: outcomes in the retrieval of nuclear fragments and subluxated intraocular lenses. The value of a cataract surgery lawsuit can vary depending on the severity of the injury, how it was caused, and the amount of medical care and treatment required. Schwartz SG, Holz ER, Mieler WF, Kuhl DP. Development of corneal edema was associated with an indemnity payment (OR, 3.50; P=.037). Clinical features and outcomes of pars plana vitrectomy in patients with retained lens fragments. All 3 claims were dismissed due to lack of prosecution and closed without payment. January 3, 2019 $500,000 Jury Verdict for Injury to Patient Whose Eyesight Was Harmed by Negligent Cataract Surgery by Robert Kreisman Deborah DeFranko was diagnosed by ophthalmologist Dr. Taylor Poole as having cataracts. Merani R, Hunyor AP, Playfair TJ, et al. Of the 66 claims that were dismissed, Texas had the most claims with 14, followed by Louisiana with 9, California with 8, Illinois with 7, Virginia and Florida each with 4, Kentucky and Colorado each with 3, Arizona, Michigan, and Missouri each with 2, and Alabama, Massachusetts, Nevada, North Carolina, Ohio, Pennsylvania, West Virginia, and Washington, DC, each with one claim. Postoperatively, the patient developed hypotony and fibrin reaction. Management of dislocated lens fragments after phacoemulsification surgery. FOIA Some cases that opened in more recent years are still open and are not a part of this study. Indemnity payment occurred in those claims that went on to a trial and a verdict in favor of the plaintiff was made or in claims that settled. The patient was informed of the complication. Wilkinson CP, Green WR. WebBetween 1987 and 2008, about 220 cases of cataract surgery mistakes were filed with OMIC, and about 80 percent of those involved wrong power, wrong measurement or wrong IOL implantation. Vitrectomy for removal of retained lens material. They found that the claims frequency for ophthalmology was slightly lower than the average for all specialties and was in between nephrology and diagnostic radiology. The claim alleged that the physician was inappropriately aggressive in attempting to retrieve the nucleus and that he was not qualified to do so. In this study, the difference between the preoperative and final visual acuity was found to be the strongest and most consistent predictor of legal outcomes for an indemnity payment and going to a trial. Ways to reduce significant vision loss, including improved management of corneal edema and IOP, and timely referral to a subspecialist should be considered. Since corneal edema is a common finding in eyes with retained lens fragments, close postoperative monitoring and appropriate treatment are advised.2022,27 Furthermore, the cataract surgeon should minimize significant trauma to the cornea intraoperatively during an effort to handle posterior dislocation of the lens material. Additional categorization and analyses were performed in this study to include claims outcomes of trial vs settlement vs dismissal in hopes of gaining additional information, such as legal expenses that may differ for these groupings, as well as to highlight factors associated with claims that result in a verdict for the plaintiff vs that for the defendant when there was a trial. If you've suffered an adverse outcome after cataract surgery, you might be wondering if you can or should sue your eye doctor for Finally, the patient must have suffered actual damage or injury as a result of negligence. In addition to the review of the closed claim cases related to the complication of retained lens fragments, other data that were thought to be relevant to the study were obtained from OMIC and analyzed for comparison with the findings from this study. Two weeks later, visual acuity was hand motions. Most people may get benefited from an IOL transplant during surgery. 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The mean defense cost for 12 cases that went on to a trial was $96,464 with a mean defense cost of $97,924 for cases with a defense verdict and $95,004 for cases with a plaintiff verdict; the mean expense for claims that were dismissed was $9,226. Borne MJ, Tasman W, Regillo C, Malecha M, Sarin L. Outcomes of vitrectomy for retained lens fragments. After the trial, the jurors were polled. In 10 cases, the tear reportedly occurred as a result of a sudden movement of the patient during surgery. The difference between the preoperative visual acuity and the final visual acuity was predictive of an indemnity payment (odds ratio [OR], 2.28; P=.001) and going to a trial (OR, 2.93; P=.000). To be insured by OMIC, an ophthalmologist must be a member of the American Academy of Ophthalmology. Retained lens fragments in resident-performed cataract extractions. Brick DC. DESCRIPTIVE STATISTICS OF THE ANALYSIS VARIABLES GROUPED BY WHETHER INDEMNITY WAS PAID. Management of retained intravitreal lens fragments after phacoemulsification surgery. This grouping was done to compare the findings of this study to other published data. AC IOL, anterior intraocular lens; OD, right eye; OMIC, Ophthalmic Mutual Insurance Company; OS, left eye; PC IOL, posterior intraocular lens; VA, visual acuity. For patients who have relatively good preoperative visual acuity, additional care should be taken during preoperative discussion and informed consent process and proper documentation should be performed as to the necessity of the surgery. Pars plana vitrectomy in the management of retained intravitreal lens fragments after cataract surgery. There were 25 cases of retinal detachment, 21 cases of corneal edema or corneal decompensation, and 18 cases of cystoid macular edema. Urological malpractice: analysis of indemnity and claim data from 1985 to 2007. Physicians with higher clinical activity also may have greater exposure or deal with more complex medical situations. Horozoglu F, Yanyali A, Macin A, Nohutcu AF, Keskinbora KH. Retained lens fragment in the anterior segment as a cause of recurrent anterior uveitis. The model was simplified using backward selection keeping all predictors with a P value of .25 or less. Furthermore, they estimated that an additional $45.59 billion was spent on defensive medicine, most of which went to pay for tests, procedures, and treatments associated with defensive medicine. 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. Of the 108 physician defendants, 94 (87%) were men and 14 (13%) were women. This is understandable, since the impact of poor final visual acuity would be greater for the patients who began with a reasonably good baseline visual acuity, and the degree of dissatisfaction would be greater as well. Stenkula S, Byhr E, Crafoord S, et al. The number of claims per 100 physicians was more than 5 times greater for general surgeons and obstetricians and gynecologists than it was for pediatricians and psychiatrists. Levinson W, Roter DL, Mullooly JP, et al. PMC legacy view Socioeconomic Characteristics of Medical Practice 1990/1991. Do Not Sell or Share My Personal Information, Do Not Sell or Share My Personal Information, improper application of anesthesia, such as globe perforation, and, a variety of post-operative complications, such as swelling, Pre-suit requirements like screening panels, advance notice of the lawsuit, mandatory settlement negotiations and ", Expert witnesses experienced in the particular field of health care must testify on behalf of either, The total amount a plaintiff can recover from a health care provider might be limited by a ". A study on causes of cataract surgery malpractice claims in England showed that claims relating to biometry errors and wrong IOL power were the second most frequent cause of claims and resulted in payment of damages in 62% of cases.73 In 9% of claims related to retained lens fragments, the capsular tear apparently was due to a sudden or uncontrollable movement of the patient during surgery. Management of nucleus loss into the vitreous: long term follow up in 63 patients. The aims of this study were to evaluate the medical malpractice claims resulting from the retained lens fragments during cataract surgery and to identify ways to improve patient outcomes. Therefore, the total cost of malpractice claims for these 108 cases was nearly $7 million. The defense experts felt that the case needed to settle because it was below the standard of care to delay referral by not recognizing endophthalmitis in a timely manner. Web7031 Koll Center Pkwy, Pleasanton, CA 94566. In addition to the original cataract surgery, patients underwent a mean of 1.3 additional surgeries (range, 04) where one or more combined procedures were performed. Therefore, it appears that earlier referral is one of the ways a cataract surgeon can improve risk management. The patient was referred 1 month after the initial cataract surgery to a retina specialist and underwent two pars plana vitrectomy surgeries, corneal wound closure, and intravitreal antibiotic injections. In contrast, 29 (45%) of 65 cases with no indemnity payment had final visual acuity of 20/200 or worse. After doing an investigation we discovered that ophthalmologists used the wrong replacement lens. Abbott RL. Before In some categories of data, not all data points were available, and those are indicated in the appropriate tables. 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. The possible outcomes are assumed to be ordered: 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. Baker PS, Spirn MJ, Chiang A, et al. Of these, 937 claims were related to cataract surgery, and 117 closed claims related to cataract surgery were complicated by retained lens fragments. Early vitrectomy was considered to be between days 3 and 7 after the cataract surgery in their study. The median time to referral was 1 week in this study. Acuity improved to 20/200, but eventually the eye became phthisical with light perception vision at 19 months after the initial cataract surgery. After your cloudy lens is removed, it will be replaced with an implanted clear artificial lens called an intraocular lens (IOL). AC IOL, anterior chamber intraocular lens; IOP, intraocular pressure; PC IOL, posterior chamber intraocular lens; VA, visual acuity. Glaucoma was defined as elevated intraocular pressure requiring pressure-lowering medication or documented visual field defect. Trial with a verdict was assumed to be a more severe outcome than settled, since historically longer duration between opening and closing of a claim and higher costs are associated with trials compared to settled claims. Kim IK, Miller JW. Some studies found that there was a decreased incidence of retinal detachment, glaucoma, or cystoid macular edema in early vitrectomy group compared to delay of more than 1 week to 1 month.34,3740 Others found only a trend toward better visual acuity outcome with earlier vitrectomy.32,33,36 Yet others found that there was no difference in terms of the incidence of retinal detachment or glaucoma or visual acuity outcome with the timing of vitrectomy.2031,35, Furthermore, there is no clear evidence that all patients with retained lens fragments need to be referred or need surgical management. Of the 108 physician defendants, 94 (87%) were men and 14 (13%) were women. In the last 2 years the femtosecond laser has been developed to assist in cataract surg Read More. Por YM, Chee SP. The new PMC design is here! Because the patient was receiving warfarin therapy, pneumatic retinopexy was performed. The difference between the preoperative visual acuity and the final visual acuity was predictive of an indemnity payment (odds ratio [OR], 2.28; P=.001) and going to a trial (OR, 2.93; P<.001). Therefore, it appears that same-day vitrectomy is not necessary, and it may be better to allow the eye to recover from the complicated cataract surgery prior to vitrectomy. Through highlighting circumstances of pertinent claims and identifying factors associated with malpractice claims resulting in an indemnity payment or going to a trial, this current study sought to ascertain steps that can be taken by ophthalmologists to improve patient care and safety as well as assist in risk management when cataract surgery is complicated by retained lens fragments. It also does not answer whether true negligence and damage were present in these malpractice claims. Retained intravitreal lens fragments after cataract surgery. Furthermore, there was a wide variation in the size of indemnity payment (payment to a plaintiff) across specialties, and the specialties that were most likely to face indemnity claims were often not those with the highest average payments.5 For example, pediatrics was 24th among 25 specialties with regard to proportion of physicians facing a malpractice claim annually, but it had the highest mean amount of indemnity payment. The time between the date of cataract surgery and the date of evaluation by a specialist to further manage the complications of retained lens fragments was a median of 7 days (range, same day to 15 months) in this study. Among the 12 claims that resulted in a jury trial, 2 cases resulted in indemnity payment. In 94 cases, a referral was made to a subspecialist. These manipulations included use of a lens loop, an attempt at impaling the lens with a microvitreoretinal blade, irrigation to float the lens, and pars plana vitrectomy by the cataract surgeon. Characteristics of physicians with obstetric malpractice claims experience. In this analysis, the following factors were found to be statistically significant for more severe legal outcome: logMAR preoperative visual acuity, logMAR final visual acuity, preoperative to postoperative change in logMAR visual acuity, development of glaucoma or elevated intraocular pressure, time to referral, and the duration between opening and closing of a case. Claims that settled during the trial or prior to the start date of the trial were included in the settlement group. Vitrectomy for retained lens fragments after phacoemulsification. Both of these were defined as glaucoma, and there were a total of 31 cases. Cohen SM, Davis A, Cukrowski C. Cystoid macular edema after pars plana vitrectomy for retained lens fragments. This study was carried out for a number of reasons: (1) the absence of published studies addressing the legal outcomes for this complication despite the number of cataract surgeries being performed in the United States; (2) tremendous interest in the management and outcomes of this potentially visually devastating complication based on the large number of published studies on this topic; (3) the relevance of study findings to both the anterior and posterior segment specialists; and (4) a potential to improve patient outcomes. A steroid drop prescribed by your ophthalmologist can help. Available at: Slora EJ, Gonzales ML. One month later, she developed a tractional retinal detachment, ciliochoroidal detachment, and hypotony. ADDITIONAL SURGICAL PROCEDURES PERFORMED TO MANAGE COMPLICATIONS FROM RETAINED LENS FRAGMENTS. Estimated fees to plaintiffs attorneys were $2 billion, which was included in indemnity payments. Hickson GB, Clayton EW, Githens PB, Sloan FA. Standard of care is what a reasonable physician would do in similar circumstances. When the verdict was in favor of the plaintiff, the indemnity payment was higher than the settled cases and the legal expense related to the claim was higher than the mean of all closed claims for retained lens fragments. The attorney listings on this site are paid attorney advertising. If observation is considered, close follow-up is recommended for timely detection of increased intraocular pressure, cystoid macular edema, or retinal detachment. More than one of these complications was noted in 31 cases. 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. Medical malpractice predictors and risk factors for ophthalmologists performing LASIK and PRK surgery. Cataract surgery: What to expect before, during and after - Harvard Health Lens extraction is done using one of two procedures: phacoemulsification or extracapsular surgery. However, the cataract surgeon did not document having made this call and the case was settled. However, there is no prospective randomized clinical trial to guide which cases should be referred for surgical management. However, when this complication is associated with retinal detachment, the visual outcome is often poor even after successful reattachment.21,6163 Development of retinal detachment was not found to be one of the factors associated with the claims outcome in this study, possibly because of small sample size or satisfactory management by the retina specialists even when retinal detachment occurred. The issue of malpractice has wide-ranging stakeholders, including our society. Claims from Florida were evenly split between those closing with an indemnity payment and those with no payment, whereas the overwhelming majority of claims from Louisiana ended with a dismissal and no payment. Cheney FW, Posner K, Caplan RA, Ward RJ. 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. Pande M, Dabbs TR. 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. Kraushar MF, Robb JH. If you have experienced complications after cataract surgery because of surgical error, consult with the St. Louis surgical error attorneys at Zevan and Davidson Law Firm, LLC at (314) 588-7200. In another study with anesthesiologists, approximately 40% of the claims did not involve substandard care but 42% of these claims ended with an indemnity payment.81, Therefore, it is difficult to clearly predict which physicians will get sued or what the final outcome of the malpractice suit will be. Another possibility for lower mean and median indemnity payments for retained lens fragments in this study may be the use of OMIC data, since mean and median payments for all closed claims are lower for OMIC-insured physicians compared to others. Sufficient and legible documentations, including visual acuity, intraocular pressure, status of the cornea, IOL position, and dilated fundus examination, are essential for risk management purposes. Aasuri MK, Kompella VB, Majji AB. The model was simplified using backward selection keeping all predictors with a P value of .25 or less. and transmitted securely. Standard of care and anesthesia liability. 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). Romero-Aroca P, Fernndez-Ballart J, Mndez-Marn I, Salvat-Serra M, Baget-Bernaldiz M, Buil-Calvo JA. She underwent pars plana vitrectomy, scleral buckling procedure, membrane peeling, removal of IOL, endolaser, and gas-fluid exchange. Whereas indemnity payment is usually associated with all settled claims, claims that go on to a trial may or may not result in an indemnity payment, depending on the verdict. 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. In all cases, final visual acuity was 20/200 or worse, including 2 cases of no light perception. 0 likes, 62 replies Report / Delete New discussion Reply 62 Replies Vanner EA, Stewart MW. Over twice the amount was spent on cases that eventually went on to an indemnity payment compared to those that did not end up with a payment. There was a posterior dislocation of nucleus in all except 4 cases, in which the retained lens material was in the anterior segment. Therefore, cases that start out with poor visual acuity and end up with poor final visual acuity are less likely to result in a trial, settlement, or indemnity payment than cases with relatively good preoperative visual acuity that end up with poor final visual acuity. Univariate descriptions of the analysis variables and the result of statistical analysis are shown in Table 7. For those claims with greater than 2 logMAR worsening in visual acuity, 62% resulted in an indemnity payment averaging $158,500. Outcome of vitrectomy for retained lens fragments after phacoemulsification. If these cases are excluded, there was a mean of 1.5 return visits to the operating room among 94 patients who had additional surgical procedures. In the first case, the cataract surgery was performed in 1989. After 2 surgeries within 2 wks on same eye, it is slow to heal, having difficulty seeing, having soreness & pain. Among 108 patient claimants, 54 were men and 54 were women. If more than one physician was named in the claim, only the data on the primary surgeon was analyzed. Furthermore, a review of closed claims by Studdert and colleagues80 showed that no injury had occurred in 3% of malpractice claims, and there had been no error in another 37% of claims. No indemnity payment was made in claims that went on to a trial but the verdict was in favor of the defendant or in claims that were dismissed or closed without compensation. Malpractice trends: viewing the data and avoiding the hot seat of litigation. CLAIMS WITH A DOCUMENTATION OF INTRAOPERATIVE MANIPULATION BY THE CATARACT SURGEON DURING MANAGEMENT OF POSTERIOR DISLOCATION OF LENS FRAGMENTS. CF, counting fingers; HM, hand motions; NLP, no light perception. Yazici AT, Kaya V, Bozkurt E, Imamoglu S, Yilmaz OF. In 91 eyes, preoperative visual acuity was recorded for both eyes. Created for people with ongoing healthcare needs but benefits everyone. One study shows that 12.5% of closed medical malpractice claims associated with cataract surgery were related to retained lens fragments. CF, counting fingers; HM, hand motion; NLP, no light perception. Delay in diagnosis or delay in referral was alleged in 12 (11%) of 108 claims. The first case closed in 1992 for $125,000, and the second case closed in 2002 for $250,000. Federal government websites often end in .gov or .mil. Bricks study on cataract surgery claims also recommends earlier referral if there was a potential for retinal complications.10. An official website of the United States government. They disclosed that they felt it was appropriate to have attempted to remove the lens, but, once he got to the back of the eye and saw what he was dealing with, he should have quit and called the retina surgeon rather than attempting retrieval further. They believed that he was not experienced enough to proceed as he had. The purpose of this paper is to explore the use of the Systems Engineering Initiative for Patient Safety (SEIPS) framework to sustainably reduce wrong intraocular lens (IOL) implants in cataract surgery. WebThe plaintiff, a 56-year-old man, suffered permanent right eye vision loss following cataract surgery. Simon JW, Ngo Y, Khan S, Strogatz D. Surgical confusions in ophthalmology. Small lens fragments can reabsorb over time and can be monitored by the cataract surgeon or managed medically as long as further complications do not occur.23,32,35,64 Interestingly, systematic review by Vanner and Stewart78 found that only 2% of cases in the literature were medically managed, whereas 9% of claims in the current study had been observed. The trial was in favor of the plaintiff with a payment of $231,754. However, when refractive surprises occur with no warning after routine cataract surgery, it is important to stay calm. Ross WH. Kraushar MF, Turner M. Medical malpractice litigation in ophthalmology: the New Jersey experience. Posterior-assisted levitation in cataract surgery. They ranged from a low of $7,500 to a high of $500,000. The vitrectomy probe was inserted in an attempt to aspirate the lens, but the lens could not be aspirated to be removed. The verdict was 6 for plaintiff and 2 for defendant. Retained lens fragments after phacoemulsification. Regan JJ, Regan WM. CF, counting fingers; HM, hand motions; NLP, no light perception. Billion, which was included in indemnity payment had final visual acuity, 62 % resulted in indemnity (! Was not experienced enough to proceed as he had with retained lens fragments PAID advertising. Physician was named in the last 2 years the femtosecond laser has developed! Were available, and hypotony 94 ( 87 % ) of 65 cases with no warning routine. Also may have greater exposure or deal with more complex medical situations warfarin therapy, pneumatic retinopexy was in... Other published data FW, Posner K, Caplan RA, Ward RJ features outcomes... Final visual acuity was 20/200 or worse, including our society the median time to referral was made a! Recommends earlier referral is one of the analysis VARIABLES and the case was settled permanent right vision. Malecha M, Sarin L. outcomes of pars plana vitrectomy in patients with retained lens fragments nucleus and he! 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