Finally, the patient must have suffered actual damage or injury as a result of negligence. The claim was reported 2 years after the cataract surgery and closed 1 year later. Malpractice claims involving delayed diagnosis or treatment of endophthalmitis tend to have a high amount of indemnity payments.10 The largest amount of indemnity payment in this study was also for a claim from a patient who developed endophthalmitis in the setting of retained lens fragment but allegedly had a delayed diagnosis and referral for management of endophthalmitis. 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. Early vitrectomy was considered to be between days 3 and 7 after the cataract surgery in their study. 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. Bohigian GM, Wexler SA. Up-irrigation of dropped nuclear fragments during phacoemulsification with the bimanual irrigation-aspiration system. When there was a trial, the verdict was likely to be in favor of the defendant, similar to most malpractice claims. The costs including indemnity payments and defense costs are summarized in Table 5. 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. Retinal detachment in eyes undergoing pars plana vitrectomy for removal of retained lens fragments. Intermittent corneal edema due to anterior segment retained lens fragments. 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. In all cases, final visual acuity was 20/200 or worse, including 2 cases of no light perception. The site is secure. Ho SF, Zaman A. Accounting for these factors, there were 108 unique cataract surgeries that met the inclusion criteria and were the basis for the current analyses. official website and that any information you provide is encrypted National costs of the medical liability system. Over 3 million cataract surgeries are performed annually in the United States.18 Given the frequency of this procedure, perhaps it is not surprising that cataract surgery is the single most frequently named procedure in malpractice actions against ophthalmologists.1315 An uncommon but potentially devastating complication of cataract surgery that can affect both the anterior segment and the posterior segment surgeons is posterior dislocation or retention of lens fragments during cataract surgery. A retinal surgeon who was called into the operating room was able to remove the nucleus using 3-port pars plana vitrectomy. If you've suffered an adverse outcome after cataract surgery, you might be wondering if you can or should sue your eye doctor for medical malpractice. Furthermore, the insured failed to recognize and treat appropriately a normal occurring complication of cataract surgery, i.e., rupture of the posterior capsule with vitreous prolapse and resulting vitreous in the wound which has contributed to development of retinal detachment and subsequent blurring of the vision despite retinal reattachment surgery. The allegations for the claims associated with cataract surgery complicated by retained lens fragments are listed in Table 4. A number of studies have found that there is substantial variation in the likelihood of malpractice suits across specialties and the cumulative risk of facing a malpractice claim is high in all specialties.26 The Physician Practice Information Survey by the American Medical Association of 5,825 physicians across 42 medical specialties, fielded in 2007 and 2008, found that an average of 95 claims were filed for every 100 physicians, almost 1 per physician, as a group.2 However, the chance of being sued each year for a physician was about 5%. Outcome of vitrectomy for retained lens fragments after phacoemulsification. There was another 29 months on average until the closure of a claim. Physician age ranged from 31 to 72 years (mean, 49 years). Bethesda, MD 20894, Web Policies 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. Claims that were dismissed, dropped, or closed without compensation were combined as dismissed, and the term dismissed was used interchangeably with closed without compensation, dropped, and withdrawn, unless specified. 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. Levinson W, Roter DL, Mullooly JP, et al. Mean change in visual acuity between preoperative visual acuity and final visual acuity for all patients was a worsening of 2 lines. 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. Mean final visual acuity was 20/200 (range, 20/20 to no light perception). Michels RG, Shacklett DE. WebIt was discovered that a 23-power lens was inserted in the left eye, instead of the intended 20-power lens. Oruc S, Kaplan HJ. Thirty-four cases had other complications, including endophthalmitis, vitreous hemorrhage, choroidal detachment, macular hole formation, central retinal artery occlusion, uveitis, anterior ischemic optic neuropathy, floaters, and epiretinal membrane. Development of corneal edema was associated with an indemnity payment (OR, 3.50; P=.037). Before One analysis was performed with the litigation outcomes divided into (1) trial, (2) settlement, and (3) dismissed. For those claims with greater than 2 logMAR worsening in visual acuity, 62% resulted in an indemnity payment averaging $158,500. 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). Time to additional surgical procedures such as vitrectomy was at the discretion of the subspecialist. 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. 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. Malpractice risk according to physician specialty. The needle impaled the lens and tore the lens capsule. Among 108 patient claimants, 54 were men and 54 were women. Delay in diagnosis or delay in referral was alleged in 12 (11%) of 108 claims. In 7 cases, the cataract surgeon documented an intraoperative attempt at retrieval of the lens fragment (Table 2). Same-day versus delayed vitrectomy with lensectomy for the management of retained lens fragments. Although documentation of informed consent does not prevent a malpractice claim, a better informed decision process may set realistic expectations by a patient, and presence of an appropriate informed consent is crucial when there is a malpractice claim. However, when refractive surprises occur with no warning after routine cataract surgery, it is important to stay calm. 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. Medical liability claim frequency: a 20072008 snapshot of physicians. Occurrence of retained lens fragments after phacoemulsification in The Netherlands. ACOG Committee Opinion No.374. 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. 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. The estimated incidence of the complication of retained or dropped lens fragment in the literature is 0.1% to 1.6% of cataract surgeries, but in the current study 12.5% of closed claims related to cataract surgery were associated with retained lens fragments. The This is without adjustment for potential differences in dollar amount due to inflationary changes. Cataract surgery involves removing a cloudy lens from the patient's eye and replacing it with a clear, artificial lens. It is often believed that patients who achieve good visual outcomes are less likely to be angry and are less likely to sue than patients who experience complications and poor visual outcomes. 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. When the complication resulted in a claim, there was an average of 15.5 months between the cataract surgery and opening of the case by the insurance company, which was soon after the insureds notification of being served with the litigation paper. However, all claims with a record of aggressive intraoperative manipulation by the cataract surgeon resulted in retinal detachment. 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