Pars plana vitrectomy for the management of retained lens material after cataract surgery. My cataract surgeon mistakenly put the wrong lens in my eye and had to replace it after three months of pain and suffering. More than 50% of obstetricians and gynecologists have already been sued before they reached the age of 40 years, and 90% of general surgeons aged 55 years and older have been sued. Those with valid cataract surgery malpractice Miller KP. 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. Merani R, Hunyor AP, Playfair TJ, et al. Baldwin LM, Larson EH, Hart LG, et al. Retained lens fragment in the anterior segment as a cause of recurrent anterior uveitis. Previous studies have shown that useful information can be gained from evaluation of malpractice claims data.3,515 However, most of the previous studies that estimated specialty-specific malpractice risk from actual claims data are not recent, and only a handful of studies specifically address the specialty of ophthalmology.516 In the most recently published study, Jena and colleagues5 analyzed closed malpractice claims for 40,916 physicians who were covered for at least one policy year from 1991 through 2005, including 807 ophthalmologists insured during the study period. 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. The median time to referral was 1 week in this study. Kim JE, Flynn HW, Jr, Rubsamen PE, Murray TG, Davis JL, Smiddy WE. Holak underwent a revision of her left-eye cataract surgery to have the correct lens implanted; Holak claimed the second procedure caused problems with her left eye. Yazici AT, Kaya V, Bozkurt E, Imamoglu S, Yilmaz OF. If observation is considered, close follow-up is recommended for timely detection of increased intraocular pressure, cystoid macular edema, or retinal detachment. Yet three or four years ago, UCLA surgeons However, as consultants, vitreoretinal surgeons should remember that they are still at a risk for being included in lawsuits directed toward other physicians and may be named as primary defendants due to significant potential for severe visual impairment among the conditions they manage.16. 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. Univariate descriptions of the analysis variables grouped by the presence of indemnity payment are shown in Table 6. Physicians with higher frequency of patient complaints may indicate less attention to interpersonal or technical aspects of patient care.2,8691 Interestingly, a physicians credentials, such as board certification, ranking of medical school attended, and foreign medical school graduate vs US graduate, did not have a significant impact on whether a physician was more likely to get sued or not.4 However, various studies indicate that the risk of being sued appears to be related to patients dissatisfaction, which may be related to their physicians ability to establish rapport, provide access, administer care consistent with expectations, and communicate effectively and in a timely fashion.4, 8791 Other physicians who subsequently manage the patient may also have a role in the patients decision to bring a claim.91. Who sues their doctors? 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. The trial verdict was for the plaintiff in the amount of $125,000, although the initial demand was for $450,000. Total cost of defense for all 108 claims was $3,312,688. Bohigian GM, Wexler SA. Borne MJ, Tasman W, Regillo C, Malecha M, Sarin L. Outcomes of vitrectomy for retained lens fragments. To review malpractice claims associated with retained lens fragments during cataract surgery to identify ways to improve patient outcomes. 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. Finally, the patient must have suffered actual damage or injury as a result of negligence. Levinson W, Roter DL, Mullooly JP, et al. Margherio RR, Margherio AR, Pendergast SD, et al. Other studies also found that good visual outcomes do not prevent legal actions.10,92. Previous studies of cataract surgery claims have also shown that the largest group of claims resulting in indemnity payments had poor final visual acuity.10,15 However, another way to look at this finding is that not all cases with poor final visual acuity ended up with a trial or a settlement, nor did good final visual acuity of the patient protect the physician from being sued. Factors associated with these claims and claims outcomes were analyzed. Review of the literature indicates that complications associated with retained lens material include inflammation, corneal edema, elevated intraocular pressure, hypotony, subluxation or dislocation of IOL, retinal tears or detachments, vitreous hemorrhage, choroidal hemorrhage, cystoid macular edema, epiretinal membrane, and endophthalmitis. The amount of indemnity payment for each grouping of final visual acuity among cataract surgeries complicated by retained lens fragments. Why do people sue doctors? Malpractice risk according to physician specialty. Currently OMIC is the largest insurer of ophthalmologists, with 40% of the market share, and has twice as many ophthalmologists as policyholders as the next largest insurer of ophthalmologists.17 Claims data from OMIC has been utilized in other previous studies related to ophthalmology.911 The OMIC Risk Management Committee gave approval for this study and granted access to the data under agreements protecting the identities of the patients, surgeons, and institutions. von Lany H, Mahmood S, James CR, et al. Retinal detachment in eyes undergoing pars plana vitrectomy for removal of retained lens fragments. 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. Vitrectomy for retained lens fragments after phacoemulsification. DESCRIPTIVE STATISTICS OF THE ANALYSIS VARIABLES BY CLAIMSOUTCOME ASSOCIATED WITH RETAINED LENS FRAGMENT. Depending on the medical malpractice laws in your state, the unique procedures and limitations might include: (To find the law in your state, choose from this chart.). Average defense costs per claim were $30,692 and ranged from a low of $0 to a high of $190,961. However, he could not complete the surgery and his retinal colleague needed to intervene intraoperatively. Of the 12 claims resulting in a trial, 30 claims resulting in a settlement, and 66 claims resulting in a dismissal, the male-to-female physician defendant ratios were 12:0, 25:5, and 57:9, respectively. If more than one physician was named in the claim, only the data on the primary surgeon was analyzed. Tackling the dropped nucleus. Every year, millions of people have routine surgery to replace a cataract that is, a lens in the eye that has become clouded. Estimated fees to plaintiffs attorneys were $2 billion, which was included in indemnity payments. In 10 cases, the tear reportedly occurred as a result of a sudden movement of the patient during surgery. Follow Posted 4 years ago, 24 users are following. Jena AB, Seabury S, Lakdawalla D, Chandra A. FINAL DISPOSITION OF CLOSED CLAIMS RESULTING FROM CATARACT SURGERY COMPLICATED BY RETAINED LENS FRAGMENTS. Retained nuclear fragment in the anterior segment. They found significantly better clinical outcomes with earlier vitrectomy for retained lens fragments with regard to visual acuity, retinal detachment, increased intraocular pressure, intraocular infection, and inflammation. Factors that prompted families to file malpractice claims following perinatal injuries. This may reflect bias in reporting surgical cases in the literature related to this complication or tendency toward legal actions when the patient feels not enough was done with observation alone. After 2 surgeries within 2 wks on same eye, it is slow to heal, having difficulty seeing, having soreness & pain. Kwok AK, Li KK, Lai TY, Lam DS. Although cataract procedures have become fairly routine and rarely have serious complications, there are some risks still associated with the surgery. Mean final visual acuity was 20/200 (range, 20/20 to no light perception). Their analysis also found that vitrectomy on the same day and up to 2 days after the cataract surgery had poorer visual outcome. These are a miniscule fraction of the tens of millions of cataract surgeries performed over the same period. In one study that did attempt comparison of observation vs vitrectomy, randomization was not possible because of bias toward vitrectomy for larger lens fragments and more severe inflammation.40. Kachalia A, Kaufman SR, Boothman R, et al. Twelve (11%) of 108 claims were resolved by a trial, 30 (28%) were settled, and 66 (61%) were dismissed. The distribution of claims resulting in a trial, settlement, dismissal, and indemnity payment seen in this study compares favorably to the current medical liability market for all medical specialties. Management of dislocated lens material. Accounting for these factors, there were 108 unique cataract surgeries that met the inclusion criteria and were the basis for the current analyses. When evaluated for indemnity payment or no payment, the male-to-female physician ratios were 27:5 and 66:9, respectively. Teo L, Chee SP. Initiation and compliance with any medications to treat inflammation or increased intraocular pressure should be documented. 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. Ways to reduce significant vision loss, including improved management of corneal edema and IOP, and timely referral to a subspecialist should be considered. Even when a trial ended in favor of a defendant and no payment was made to the plaintiff, the legal expenses were nearly twice that of claims that settled. 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. This division allowed additional information regarding the duration between opening and closing of the claim and legal expenses for each group. If a surgeon who had some retinal training was deemed not specialized enough to manage such a case, it may be best for most cataract surgeons to seek expertise of a retina specialist and avoid aggressive retrieval. Greven CM, Piccione K. Delayed visual loss after pars plana vitrectomy for retained lens fragments. In 7 cases, the cataract surgeon documented an intraoperative attempt at retrieval of the lens fragment (Table 2). Mello MM, Chandra A, Gawande AA, Studdert DM. 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. These items can be broadly separated into those pertaining to (1) the physician, (2) the patient, (3) preoperative, intraoperative, and postoperative clinical data, and (4) the litigation. Smiddy WE, Flynn HW, Jr, Kim JE. official website and that any information you provide is encrypted Arbisser LB, Charles S, Howcroft M, Werner L. Management of vitreous loss and dropped nucleus during cataract surgery. Among the 108 cases in this study, the final dispositions of the claims were as follows: 12 cases (11%) were resolved by a trial, of which 2 cases (17%) resulted in a verdict in favor of the patient plaintiff and 10 cases (83%) cases with a verdict in favor of the physician defendant; 30 cases (28%) were settled; and 66 cases (61%) were dismissed. WebAllegation Wrong power IOL insertion led to complicated lens exchange surgery. Day S, Menke AM, Abbott RL. HHS Vulnerability Disclosure, Help Posterior-assisted levitation in cataract surgery. Bhan A, Dave D, Vernon SA, Bhan K, Bhargava J, Goodwin H, Medical Defense Union; Medical Protection Society; Medical and Dental Defense Union of Scotland Risk management strategies following analysis of cataract negligence claims. 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 ". Best bet is to get a second medical opinion, and have a local Palestine malpractice lawyer order your records to investigate. Use Avvo's lawyer fin Kraushar MF. Vincent C, Young M, Phillips A. Lu H, Jiang YR, Grabow HB. Retained lens fragments after phacoemulsification. 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. 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. In: Gonzalez ML, Zhang P, editors. My vision actually was worse after the lens placement. Spicer J. For the current study, the claims were categorized into those that went on to a trial, settlement, or dismissal, and those with or without indemnity payment. The defendant prevailed in 83% of trials. In vitreous specimens of eyes with a history of retained lens fragments, the amount of inflammation increased starting 3 days after the retained lens fragments and increased substantially in eyes with delayed vitrectomy for more than 30 days when compared to less than 30 days.72 Therefore, ancillary testing such as optical coherence tomography should be used to document absence of cystoid macular edema, which may result from persistent inflammation, and ultrasonography should be considered in the setting of significant inflammation with diminished view to the posterior segment to detect possible retinal detachment. Blodi BA, Flynn HW, Jr, Blodi CF, Folk JC, Daily MJ. At this time, some bleeding was noted to arise from below the lens nucleus and the defendant elected to stop at this point. Simon and colleagues12 found that the most common surgical confusion in ophthalmology was use of the wrong IOL implants. An opening in the inferior portion of the posterior capsule was seen and retinal detachment was confirmed. Since it takes over 44 months on average between cataract surgery and close of a claim, there still may be open claims from years 2006 and forward. Seven hundred medicolegal cases in ophthalmology. PMC legacy view This is without adjustment for potential differences in dollar amount due to inflationary changes. Vitrectomy for retained lens material after cataract extraction: the relationship between histopathologic findings and the time of vitreous surgery. The negligent act must be a proximate cause of the plaintiffs injuries, which means the act was necessary for the injury when and in the manner it occurred, and the injury must be a foreseeable consequence of the negligent act. The costs including indemnity payments and defense costs are summarized in Table 5. The most common additional surgical procedure was pars plana vitrectomy to remove retained lens material or to manage retinal detachment, but procedures to manage IOL, glaucoma, corneal decompensation, and strabismus were also performed (Table 3). While some advocate vitrectomy to be performed on the same day as the day of complicated cataract surgery, many retinal surgeons prefer waiting the first few days after cataract surgery to permit the corneal edema to clear to allow unimpeded visualization of the retina.25,28,53 Vanner and Stewart78 performed a systematic review of 43 studies, including meta-analysis of 27 studies, for timing of vitrectomy for retained lens fragments after cataract surgery. She underwent pars plana vitrectomy, scleral buckling procedure, membrane peeling, removal of IOL, endolaser, and gas-fluid exchange. 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. Among these, the patients sought a second opinion and referred themselves in 3 cases. Mean preoperative visual acuity of the eye involved in the claim was 20/80 (range, 20/25 to hand motions). If you and your attorney manage to navigate the many procedural requirements, find an expert witness and demonstrate to the other side that you probably have a winning case, the final wrangling in the case will be over just what kind of damages resulted from your ophthalmologist's negligence, i.e. In one case, the physicians honesty was questioned when the operative note was dictated 1 week after the incident and appeared to be dictated in a manner to cover up the damages. Dr. Poole performed cataract surgery on DeFrankos eyes over the course of one month. Retained nuclei after cataract surgery. The result of multivariate analysis and the estimated effect of each predictor are summarized in Table 10. Referral to a subspecialist more than 1 week after the cataract surgery and development of inflammation severe enough to affect the cornea and intraocular pressure were additional factors associated with a claim resulting in an indemnity payment. 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. 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