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. 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. The defendant prevailed in 83% of trials. Dr made larger incision & needed stitches. Although not found to be an associated factor for the claim resulting in a trial or an indemnity payment, inflammation from the lens material can also result in poor final visual acuity due to development of cystoid macular edema and chronic uveitis.20,28,5254 Even when the lens material is retained in the anterior segment, significant and chronic inflammation can occur and may require surgical intervention.5559. 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.). 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. Retinal detachment in eyes undergoing pars plana vitrectomy for removal of retained lens fragments. Physician-patient communication. Lu H, Jiang YR, Grabow HB. Cases to be included in the study were identified based on OMIC coding for claims resulting from complications related to cataract surgery. Accessibility Average defense costs per claim were $30,692 and ranged from a low of $0 to a high of $190,961. Claims that settled during the trial or prior to the start date of the trial were included in the settlement group. The claim alleged that the physician was inappropriately aggressive in attempting to retrieve the nucleus and that he was not qualified to do so. The 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. Most previous studies on malpractice claims compared only the groups that went on to indemnity payment vs no payment. Of these cases, 11% went to trial, 28% settled, and 61% were dismissed. Even when an IOL was initially placed at the time of complicated cataract surgery, subsequent dislocation of IOL occurred in 6 cases. WebSurgery for cataracts involves removing the cataract-ridden lens of the eye and either replacing it with an artificial lens called an IOL implant or compensating for its absence with eyeglasses or contact lenses. WebUltrasound: The predominant technology for cataract removal is ultrasound. After the trial, the jurors were polled. 23-gauge transconjunctival pars plana vitrectomy for removal of retained lens fragments. Endophthalmitis in patients with retained lens fragments after phacoemulsification. 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. 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. The most common risks are: Although you may have experienced an unexpected outcome, even a severe injury, that does not mean medical malpractice is necessarily the cause. Management of retained lens fragments after cataract surgery with and without pars plana vitrectomy. National costs of the medical liability system. 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. The lower number of claims in the recent years may indicate increased awareness by the cataract surgeons in optimal management of this complication. Blodi BA, Flynn HW, Jr, Blodi CF, Folk JC, Daily MJ. Another study found that 7.4% of all physicians had a malpractice claim each year, with 1.6% having a claim leading to a payment.5 The proportion of physicians facing a claim each year ranged from 2.6% in psychiatry to 19.1% in neurosurgery. There were 25 cases of retinal detachment, 21 cases of corneal edema or corneal decompensation, and 18 cases of cystoid macular edema. More than one of these complications was noted in 31 cases. Kraushar MF, Turner M. Medical malpractice litigation in ophthalmology: the New Jersey experience. However, there is no prospective randomized clinical trial to guide which cases should be referred for surgical management. Simon JW, Ngo Y, Khan S, Strogatz D. Surgical confusions in ophthalmology. 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. 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. Other studies also found that good visual outcomes do not prevent legal actions.10,92. Kim JE, Flynn HW, Jr, Rubsamen PE, Murray TG, Davis JL, Smiddy WE. WebThere has been a large interest over the years in clinical outcomes and management of retained lens fragments as evidenced by the substantial number of articles continuing to Most people may get benefited from an IOL transplant during surgery. 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. Characteristics of physicians with obstetric malpractice claims experience. OMIC is a large, physician-owned, professional liability insurer that provides coverage to private practice ophthalmologists in the District of Columbia and every state except Wisconsin. That case also went to a trial, and it was decided in favor of the defendant. Olsson RB, Ritland JS, Bjrnsson OM, Syrdalen P, Eide N, Overgrd R. A retrospective study of patients with retained nuclear fragments after cataract extraction. 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. ADDITIONAL SURGICAL PROCEDURES PERFORMED TO MANAGE COMPLICATIONS FROM RETAINED LENS FRAGMENTS. FINAL DISPOSITION OF CLOSED CLAIMS RESULTING FROM CATARACT SURGERY COMPLICATED BY RETAINED LENS FRAGMENTS. On average, a claim took 28.8 21.2 months to close. Mean change in visual acuity between preoperative visual acuity and final visual acuity for all patients was a worsening of 2 lines. Pande M, Dabbs TR. The cataract surgeon felt strongly that he was not at fault and wished to go to a trial rather than settle. Boscher C, Lebuisson DA, Lean JS, Nguyen-Khoa JL. Hansson LJ, Larsson J. Vitrectomy for retained lens fragments in the vitreous after phacoemulsification. Outcome of vitrectomy for retained lens fragments after phacoemulsification. .I have macular degeneration in the left eye so a technical lens would not have made a difference. 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 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. Factors that prompted families to file malpractice claims following perinatal injuries. The retina successfully reattached with a final visual acuity of 20/25. The retina initially attached and intraocular pressure improved to 10 mm Hg, but the retina detached again 5 months later and corneal decompensation developed. Among the 108 claims, 107 claims had a record of which eye was operated on; 42 cases (39%) involved the right eye and 65 (61%) involved the left eye. AC IOL, anterior intraocular lens; OD, right eye; OMIC, Ophthalmic Mutual Insurance Company; OS, left eye; PC IOL, posterior intraocular lens; VA, visual acuity. A suit is defined as a formal legal action initiated in the courts by the filing of a complaint seeking a remedy (usually money) by the plaintiff and requiring a formal response from the physician or the entity (defendant). There has been a large interest over the years in clinical outcomes and management of retained lens fragments as evidenced by the substantial number of articles continuing to be written on this topic.1978 The incidence of retained or dropped lens fragments during cataract surgery is estimated to be between 0.1% and 1.6% of cataract surgeries.18,19,23,29,45,54,64 There are numerous articles to indicate that a capsular tear with retained lens fragment is a well-known complication of cataract surgery.2049 Studies show that reasonably favorable visual outcome can be obtained with intervention usually in the form of pars plana vitrectomy.2049,7477 Therefore, encountering this complication in itself would not be a malpractice. 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. However, optimal timing of vitrectomy is unknown, and the effect of vitrectomy timing on clinical outcomes has been highly controversial.2041,74,78 Therefore, there is currently no clarity in best time to refer to a specialist in cases of cataract surgeries complicated by retained lens fragment or the time between referral to vitrectomy. Vitrectomy timing for retained lens fragments after surgery for age-related cataracts: a systemic review and meta-analysis. Furthermore, certain eyes are known to have an increased risk for developing this complication, including eyes with prior trauma, pseudoexfoliation, dense cataract, and history of having had prior vitrectomy surgery.42,49 Therefore, additional care should be taken during the cataract surgery in these eyes. WebMedical board investigations are now often triggered by mandatory reports from surgery centers and hospitals. 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. Finally, retinal detachment is a frequent adverse event in these eyes and can occur after the complicated cataract surgery or after vitrectomy surgery to remove the lens material.21,28,31,36,38,6165 Therefore, both the cataract surgeon and the retinal surgeon need to closely follow these patients for retinal detachment. 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. 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