Ophthalmology expert witness advises on cataract surgery that resulted in vision loss from corneal burn

An ophthalmology expert witness advises on a case involving a cataract surgery patient who lose her vision due to a corneal burn. Plaintiff underwent cataract phacoemulsification (routine cataract surgery) with insertion of an intraocular lens on her right eye. Midway during the procedure, the machine started chiming an alarm. It was removed and later reinserted. She was told by defendant doctor that her vision would steadily improve. When it did not, and she continued seeing black spots, she sought treatment from another ophthalmologist. The second doctor said she had a corneal burn, scarring and thinning. She ultimately underwent astigmatic keratotomy on her right eye to relax the incisions. Following that procedure, she complained of a film blurring her vision. Her vision in that eye was 20/80. A third ophthalmologist diagnosed the plaintiff with having a hole in her eye that put her at risk for a detached cornea.

As a result of her lost vision, plaintiff has only been able to work a few hours a week. She sued the initial ophthalmologist for medical negligence.

Question(s) For Expert Witness

1. What did the medical reports indicate?

2. Did the ophthalmologist violate the standard of care?

Expert Witness Response

There are some inconsistencies with the reported events and the outcome of severe corneal burn. If the phacoemulsification power was changed to infusion, as reported by the defendant, only after the phacoemulsification machine began to chime, there would be little time for a corneal burn of this severity to occur. Although there are many reasons why a corneal burn can occur, including an empty infusion bottle, infusion bottle height too low, irrigation tubing crimped, occlusion/clogged phacoemulsification tip, too tight of an incision or even improper tuning of the phacoemulsification machine, most of these situations should be recognized, identified, and rectified in a timely fashion to prevent severe corneal burns.

In the operative report, the statement that after the cornea was noted to turn white at the incision site, the “phacoemulsification was re-tuned and then the phacoemulsification probe was reinserted” leads to speculation that perhaps the machine was improperly tuned at the beginning of the case. There have been documented cases of corneal burns as a result of improper tuning of the phacoemulsification machine. Regardless of the actual cause, the complication of a severe corneal burn, causing scarring and high astigmatism, deviates from what would be considered standard of care for phacoemulsification surgery.