Vitrectomy for retained lens fragments after phacoemulsification. Hui JI, Fishler J, Karp CL, Shuler MF, Gedde SJ. Breach of duty occurs when the physician fails to follow the standard of care for the patients condition. Clinical features and outcomes of pars plana vitrectomy in patients with retained lens fragments. You should consult with an attorney in your state as soon as possible. Time limitations apply so be aware of them. Check Avvo for a listing of atto During the 21-year period, 117 (12.5%) of 937 closed claims associated with cataract surgery were related to retained lens fragments with 108 unique cataract surgeries, 97% against cataract surgeon and 3% against retinal surgeon. Accessibility The retina specialist confirmed that the IOL was well positioned without vitreous in the anterior segment. Management of dislocated nuclear fragments after phacoemulsification. Yang CS, Lee FL, Hsu WM, Liu JH. Therefore, while retained lens fragment is an infrequent complication of cataract surgery, this complication has a potentially high likelihood of legal consequences. Oruc S, Kaplan HJ. Univariate descriptions of the analysis variables grouped by the presence of indemnity payment are shown in Table 6. Greven CM, Piccione K. Delayed visual loss after pars plana vitrectomy for retained lens fragments. 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. 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. The average cataract surgery settlement was for $192,865. Your use of this website constitutes acceptance of the Terms of Use, Supplemental Terms, Privacy Policy and Cookie Policy. 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. This gender spread was compared with OMIC data on demographics. All of these cases had a final visual acuity of 20/200 or worse, and 5 of 7 of these claims either went on to a trial or settled. Vanner EA, Stewart MW. Schutz JS, Mavrakanas NA. Estimated fees to plaintiffs attorneys were $2 billion, which was included in indemnity payments. Although cataract procedures have become fairly routine and rarely have serious complications, there are some risks still associated with the surgery. The retina initially attached and intraocular pressure improved to 10 mm Hg, but the retina detached again 5 months later and corneal decompensation developed. Medical malpractice experiences of vitreoretinal specialists: risk prevention strategies. Gilliland GD, Hutton WL, Fuller DG. 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. .I have macular degeneration in the left eye so a technical lens would not have made a difference. Once an insured becomes aware that a wrong site surgery or incorrect power iOL insertion has occurred, the incident should be reported to OMICs Claims Department or confidential Risk Management hotline at (800) 562-6642, option 2 In the univariate analysis, final visual acuity, development of corneal edema, and the difference between preoperative visual acuity and final visual acuity were found to be statistically significant. Learn more There was a posterior dislocation of nucleus in all except 4 cases, in which the retained lens material was in the anterior segment. 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. government site. Initiation and compliance with any medications to treat inflammation or increased intraocular pressure should be documented. The final visual acuity for claims resulting in indemnity payment vs no payment is shown in Figure 5. She underwent corneal transplantation, pars plana vitrectomy, membrane peeling, and silicone oil placement. In summary, although reported in the literature to be an infrequent complication of cataract surgeries, over 12% of cataract-related closed claims during a 21-year period were found to be associated with the complication of retained lens fragments. In 11 eyes, the operated eye was the better eye. In comparison, 30% of 108 claims related to retained lens fragments resulted in an indemnity payment with an average payment of $117,688. In 91 eyes, preoperative visual acuity was recorded for both eyes. Pande M, Dabbs TR. Web7031 Koll Center Pkwy, Pleasanton, CA 94566. Vitrectomy with endoscopy for management of retained lens fragments and/or posteriorly dislocated intraocular lens. 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. Retained lens fragments in resident-performed cataract extractions. In comparison, indemnity payment for all closed claims for OMIC is a mean of $150,000 and median of $75,000. Tackling the dropped nucleus. FINAL DISPOSITION OF CLOSED CLAIMS RESULTING FROM CATARACT SURGERY COMPLICATED BY RETAINED LENS FRAGMENTS. The majority of eyes developed one or more ocular complications following surgery, many of which contributed to poor visual outcome. 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. Bricks study on cataract surgery claims also recommends earlier referral if there was a potential for retinal complications.10. Also, claims with worse final visual acuity tended to have higher indemnity payments (Figure 6). Murat Uyar O, Kapran Z, Akkan F, Cilsim S, Eltutar K. Vitreoretinal surgery for retained lens fragments after phacoemulsification. In all cases, final visual acuity was 20/200 or worse, including 2 cases of no light perception. In most states, some form of special procedural rules exist for medical malpractice cases, and these rules are specifically designed to make suing a health care provider more difficult, when compared with "ordinary" civil cases for personal injury. In 7 cases, the cataract surgeon documented an intraoperative attempt at retrieval of the lens fragment (Table 2). 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. Fastenberg DM, Schwartz PL, Shakin JL, Golub BM. Stilma JS, van der Sluijs FA, van Meurs JC, Mertens DA. Aasuri MK, Kompella VB, Majji AB. My father had cataract surgery two years ago. Posterior-assisted levitation in cataract surgery. 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. 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. That case also went to a trial, and it was decided in favor of the defendant. Factors associated with these claims and claims outcomes were analyzed. Even when an IOL has been inserted by the cataract surgeon, the retinal surgeon should be prepared to manage subsequent complications of dislocated or malpositioned IOL, as was the case in some of the claims in this study. Whereas the majority of claims were dismissed, claims associated with greater visual acuity decline, corneal edema, or elevated IOP were more likely to result in a trial or payment. 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. 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. Indemnity payments totaling more than $3,586,000 were made in 32 (30%) of the claims (median payment, $90,000). The last variable was not included in the predictive model because it is not a preclaim covariate, but rather a type of outcome. ESTIMATES FROM THE MULTIVARIATE LOGISTIC REGRESSION MODEL FOR INDEMNITY PAYMENT AMONG CATARACT SURGERIES COMPLICATED BY RETAINED LENS FRAGMENTS. 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. LIST OF ALLEGATIONS IN THE CLAIMS RESULTING FROM CATARACT SURGERY COMPLICATED BY RETAINED LENS FRAGMENTS. In 10 cases, the tear reportedly occurred as a result of a sudden movement of the patient during surgery. May M, Stengel B. Physician surveys and actuarial data show that one risk factor for lawsuit is the area of specialty, where surgeons, obstetricians, and gynecologists are sued more often than physicians from nonsurgical specialties.25,82 Other studies have shown that the claim frequencies increase with increasing age of the physician, physicians with higher clinical activity, male gender, a previous claims history, and higher frequency of patient complaints. The retina successfully reattached with a final visual acuity of 20/25. Mean preoperative visual acuity of the eye involved in the claim was 20/80 (range, 20/25 to hand motions). Kachalia A, Kaufman SR, Boothman R, et al. Postoperatively, the patient developed hypotony and fibrin reaction. All cases, the patient developed hypotony and fibrin reaction LOGISTIC REGRESSION model for indemnity payment for all closed for. 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