ADDITIONAL SURGICAL PROCEDURES PERFORMED TO MANAGE COMPLICATIONS FROM RETAINED LENS FRAGMENTS. What helps? 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. Learn how we can help. In another case, the operative note was the usual macro for standard cataract surgery and did not seem to take into account the problems encountered during the surgery. In addition to alleged negligent cataract surgery with retained lens fragments, placement of the wrong IOL was cited as a contributing negligence in 3 cases: (1) placement of wrong-powered IOL handed to the surgeon by a nurse; (2) not having the correct type of IOL to insert in the setting of capsular rupture, resulting in increased likelihood of subsequent dislocation of IOL; and (3) placement of wrong-powered IOL due to incorrect transfer of A-scan data by a technician. Acknowledgments: J.K. would like to thank Dr Harry Flynn Jr for critical reading of the manuscript, his mentorship, and getting her interested in the topic of retained lens fragments. Cataracts cause foggy or blurred vision that makes it hard to do everything from reading to The mean payment was $117,688, and the median payment was $90,000. 8600 Rockville Pike 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. ESTIMATES FROM THE MULTIVARIATE LOGISTIC REGRESSION MODEL FOR INDEMNITY PAYMENT AMONG CATARACT SURGERIES COMPLICATED BY RETAINED LENS FRAGMENTS. Their analysis also found that vitrectomy on the same day and up to 2 days after the cataract surgery had poorer visual outcome. The doctor-patient relationship and malpractice: lessons from plaintiff depositions. 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. Jena AB, Seabury S, Lakdawalla D, Chandra A. Ophthalmic malpractice lawsuits with large monetary awards. There was another 29 months on average until the closure of a claim. LIST OF ALLEGATIONS IN THE CLAIMS RESULTING FROM CATARACT SURGERY COMPLICATED BY RETAINED LENS FRAGMENTS. The payment was significantly larger when it was after a trial verdict, with an average of $187,500, whereas average payment for the settled claims was $107,033. Medical malpractice cases present a complex interaction between medical and legal issues, and it typically takes an experienced medical malpractice attorney working alongside a well-qualified expert witness to present the best case. Although the final visual acuity was important, the most important factor associated with going to a trial or resulting in an indemnity payment was found to be the amount of visual acuity loss following cataract surgery complicated by retained lens fragments, such that the greater the difference between the baseline visual acuity and the final visual acuity, the greater the likelihood of a claim resulting in a trial or indemnity payment. Factors that prompted families to file malpractice claims following perinatal injuries. 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. Conservative management could be considered for eyes with good baseline visual acuity. National Library of Medicine My vision actually was worse after the lens placement. 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. 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. 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. Although claims from Illinois, Texas, and California accounted for 42% of all claims, claims from Illinois were more likely to go to trial or settlement, and claims from Texas and California were more likely to be dismissed. CF, counting fingers; HM, hand motions; NLP, no light perception. 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 ". Colyer MH, Berinstein DM, Khan NJ, et al. WebCataract surgery injury occurs in approximately 12% of cases. The patient claimed that the physician should have Kageyama T, Ayaki M, Ogasawara M, Asahiro C, Yaguchi S. Results of vitrectomy performed at the time of phacoemulsification complicated by intravitreal lens fragments. CF, counting fingers; HM, hand motions; NLP, no light perception. For the use in multivariate modeling, an optimal transformation from the Box-Cox family was calculated for each nonnegative continuous variable. Obstetricians prior malpractice experience and patients satisfaction with care. Of these, 937 claims were related to cataract surgery, and 117 closed claims related to cataract surgery were complicated by retained lens fragments. Time between cataract surgery and referral to a subspecialist was a median of 7 days, ranging from the same day as the cataract surgery to 15 months after cataract surgery. Of these cases, 11% went to trial, 28% settled, and 61% were dismissed. The frequency of claims related to retained lens fragments compared to the number of policyholders for each year from 1989 through 2009. The site is secure. Incidence of lens matter dislocation during phacoemulsification. In 47 claims where the referral to a specialist was greater than 1week, 47% of claims went on to a trial or a settlement and a total of $1,986,000 were paid to the plaintiff. The term claim was used in this study to include suits, unless specified. Posterior-assisted levitation in cataract surgery. The number of Ophthalmic Mutual Insurance Company policyholders from years 1989 through -2009. Follow Posted 4 years ago, 24 users are following. Cheney FW, Posner K, Caplan RA, Ward RJ. The retina successfully reattached with a final visual acuity of 20/25. 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. Both univariate analyses and multivariate analyses were performed using data collected for possible outcomes or final disposition of the claim. Beckman HB, Markakis KM, Suchman AL, Frankel RM. Sponsored by the American Academy of Ophthalmology, OMIC is the largest professional liability insurer for ophthalmologists in the United States, currently insuring over 4,300 ophthalmologists throughout the 49 states (all states except Wisconsin). Among the 108 cases, two physicians had multiple claims relating to retained lens fragments, with 2 claims each. The verdict was 6 for plaintiff and 2 for defendant. Simon JW, Ngo Y, Khan S, Strogatz D. Surgical confusions in ophthalmology. The cataract surgeon felt strongly that he was not at fault and wished to go to a trial rather than settle. However, how this complication was managed intraoperatively and postoperatively, what degree of injury resulted, as well as how the informed consent was presented preoperatively, will determine whether or not malpractice occurred due to substandard care that resulted in harm to the patient. Ho and colleagues37 recommended that cataract surgeons refer patients with retained lens fragments to a retina specialist within 7 days for consideration of a pars plana vitrectomy to decrease the risk of developing secondary glaucoma. Schwartz SG, Holz ER, Mieler WF, Kuhl DP. Therefore, appropriate management of elevated intraocular pressure is necessary to reduce poor patient outcome. 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. Vitrectomy for removal of retained lens material. Claims data from the Ophthalmic Mutual Insurance Company (OMIC) represent a unique opportunity to examine the medicolegal risks associated with ophthalmology. Retinal detachment in eyes undergoing pars plana vitrectomy for removal of retained lens fragments. 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). Note that time to referral was log2-transformed, so an increase of one unit means doubling of time. 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. Claims were excluded when found not to pertain to retained lens fragments but were due to dislocated intraocular lens (IOL), wrong intraocular lens, endophthalmitis, or retinal detachment following cataract surgery. Same-day versus delayed vitrectomy with lensectomy for the management of retained lens fragments. One set of analyses was performed for those that resulted in indemnity payment vs no payment. Closed claims data related to cataract surgeries complicated by retained lens fragments (1989 through 2009) from an ophthalmic insurance carrier were reviewed. The management of dislocated lens material after phacoemulsification. 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. This trend may reflect increased popularity and adaptation of phacoemulsification by cataract surgeons in the mid-1990s and increased complication rates during transition period from extracapsular cataract surgery. CF, counting fingers; HM, hand motion; NLP, no light perception. Mean final visual acuity was 20/200 (range, 20/20 to no light perception). The technical lens was suppose to give me even better vision in the right eye. WebUltrasound: The predominant technology for cataract removal is ultrasound. Murat Uyar O, Kapran Z, Akkan F, Cilsim S, Eltutar K. Vitreoretinal surgery for retained lens fragments after phacoemulsification. Retained lens fragment in the anterior segment as a cause of recurrent anterior uveitis. Therefore, medical malpractice added over $55 billion to the nations total healthcare costs both directly through malpractice claims and indirectly to avoid claims.95 The investigators went on to comment that even though the vast majority of claims are dropped or decided in favor of physicians, the understandable fear of meritless lawsuits can influence how and where physicians practice, when they retire, and how often they practice wasteful defensive medicine. Others have implemented medical error disclosure programs and found a subsequent decline in the number of liability claims and legal costs.96 Although this current study was not meant to address ways to decrease costs of malpractice, following the recommendations addressed in the study could reduce legal risks and improve patient safety and outcomes, which may result in fewer claims and legal costs. 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. Simon and colleagues12 found that the most common surgical confusion in ophthalmology was use of the wrong IOL implants. 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 model was simplified using backward selection keeping all predictors with a P value of .25 or less. The data collected were chosen based on the review of the literature to have a potential relevance to the outcome of litigations in ophthalmology916 or to the clinical outcomes2065 and were obtainable from the available documents from OMIC. In one case of alleged delayed referral, the defendant stated that he made a call immediately after the complication to a retina specialist regarding recommendation for the management, but the retina specialist stated that he did not recall the conversation. The same study showed that, in terms of compensation for medical errors, the system gets it wrong about equally on both sides such that 27% of claims involving errors were uncompensated and, on the flip side, the same percentage of compensated claims did not involve an error. Management of dislocated nuclear fragments after phacoemulsification. There was additional $103,000 in legal expenses. Another claim alleged that there was a delay in time to pars plana vitrectomy by the retinal surgeon to manage the elevated intraocular pressure. 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. Also, claims with worse final visual acuity tended to have higher indemnity payments (Figure 6). Tackling the dropped nucleus. 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. Who sues their doctors? 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. 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