Ophthalmology Expert Opines on Standard of Care Following Cataract Surgery

This case takes place in Vermont and involves an elderly male patient with a past medical history of diabetes, high blood pressure, and elevated cholesterol. The patient underwent left eye extraction of a brunescent cataract. According to the records hydrodissection was performed, and then removal of the nucleus by way of phacoemulsification. At that point, there was a rupture of the posterior capsule and the lens descended into the vitreous. An anterior vitrectomy was performed and cortical material was removed with irrigation and aspiration. According to the testimony of the defendant, it appears that the rupture occurred at the very beginning of the phacoemulsification, and the entire lens descended into the vitreous humor. The defendant proceeded to place an intraocular lens into the sulcus. The patient was then referred to another physician for lensectomy-vitrectomy. Following that surgery, he had multiple procedures including air/fluid exchange, cryo, laser, vitrectomy and scleral buckling. Eventually, it was determined that the patient had a total retinal detachment with extensive PVR, both on the epi-retinal and sub retinal spaces. He underwent extensive vitrectomy, membranectomy, endolaser, and silicone oil tamponade. The patient is currently blind in his left eye.

Question(s) For Expert Witness

1.) Do you routinely treat patients similar to the one described in the case? Please explain.

2.) Do you believe this patient may have had a better outcome if the care rendered had been different?

3.) Could you review the medical records and opine on the standard of care?

4.) Have you ever served as an expert witness on a case similar to the one described above?

Expert Witness Response E-009723

I believe the major fault of surgeon was the IOL implantation when he already knew he left the whole lens nucleus in the vitreous. It is not acceptable at all. The surgeon must do an anterior vitrectomy without further manipulation and then refer the patient to a retina surgeon for nucleus removal and possible IOL placement. I do believe this patient may have had a better outcome if the care rendered had been different. We always have unpredictable complications like capsular rupture and nucleus drop, but management of that complication that is too aggressive can lead to a peripheral retinal hole and cause more retinal complications.

I have done more than 4000 cataract surgeries and have published several articles about techniques. Your case was certainly mismanaged. I can review the records and opine further on the standard of care.