The following is a list of the most common cataract surgery complications that occur as a result of malpractice.
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Scroll down to find in depth descriptions of each of these potential cataract malpractice complications.
Serious bleeding during or shortly after cataract surgery is fortunately very uncommon. If your surgeon or anesthesiologist injected anesthetic behind the eye with a needle (peribulbar block or retrobulbar block) prior to the beginning of cataract surgery, then rarely an orbital hemorrhage or bleeding behind the eye can occur. This type of complication must be addressed and treated immediately or it can cause permanent, total loss of vision. If it is managed properly then serious problems can be avoided.
Vary rarely, about 0.1% of the time, bleeding can occur inside the back of the eye during the cataract operation. This is called a choroidal (pronounced "koroidal") hemorrhage. This complication can cause permanent, severe or total loss of vision, or even loss of the eye, if it is not managed properly and immediately during the surgery. If you were using a blood thinner or anticoagulant (aspirin, plavix, clopidogrel, coumadin, heparin, warfarin, pradaxa) shortly before or during the cataract surgery, your risk of orbital hemorrhage and choroidal hemorrhage are increased. However, to reduce the chances of bleeding during and after the cataract surgery, the doctor should use specialized incisions, anesthesia and other
techniques to reduce your risks. In some cases the anticoagulants may be stopped for several days prior to or during the cataract surgery. This reduces the risk of eye bleeding but may increase the risk of getting a stroke, heart attack or other serious medical
complication. Your surgeon should discuss this with you and your primary care doctor or cardiologist before making a decision on whether to stop or continue or anticoagulants prior to and during cataract surgery. If you've had an orbital or choroidal hemorrhage, or serious medical complication as a result of cataract surgery, expert evaluation
of your medical records must be done to determine if these complications were caused by malpractice or not, and whether they were managed properly by your surgeon.
There are 4 different anesthesia techniques that can be used during cataract surgery to numb the eye so that you have no pain or only minimal discomfort during surgery.
General anesthesia (totally asleep with a breathing tube inserted into your throat) is very rarely used with modern day cataract surgery techniques. It has the highest risk for complications that can adversely affect the heart, lungs, liver, kidneys and other organs during cataract surgery.
Retrobulbar anesthesia uses a long needle to inject an anethetic solution behind the eye. This is rarely used with modern surgical techniques, but occasionally may be required.
Peribulbar anesthesia uses a short, thin needle to inject anesthetic solution behind the eye. This is used by a minority of surgeons but is acceptable if done properly and for the right type of cataract surgery.
Topical anethesia is the most common technique. It utilizes numbing eye drops on the surface of the eye, and no injections. However it requires mastering state of the art surgical techniques using phacoemulsification and small incision surgery to be effective.
Each type of anesthesia technique has its pros and cons, advantages and disadvantages. If the technique used by the surgeon is not appropriate for the type of cataract that you have, then you may suffer needless complications including loss of vision, pain, loss of the eye and serious medical complications.
Some ophthalmologists have the anesthesiologist on the surgical case give their patients the peribulbar or retrobulbar anesthetic injection behind the eye just prior to the surgery. In general, ophthalmologists have much more skill, experience and knowledge of the best technique for these injections and how to deal with any complications that may result from the injections. However, some anesthesiologists have been properly trained and are very experienced in giving these injections as well.
If you have had a cataract surgery anesthesia complication, the only way to determine if there was malpractice involved is to have an expert review of all of the surgeon's, anesthesiologist's and surgical facility's records thoroughly examined by an expert.
The cornea is the front part of the eye. It is like a crystal clear, camera lens that focuses the light and images that come into the eye. Cataract surgery usually puts mild stress on the cornea, and often the cornea will become slightly coudy after the surgery. This
usually resolves after several days or weeks allowing the vision to clear after the surgery. If it does not resolve then your vision may stay permanently hazy, cloudy or blurry, and you may also experience moderate to severe pain.
Some people have abnormalities of the cornea which puts them at higher risk of developing corneal clouding after surgery. If you have this condition, your surgeon should use extra special precautions during surgery to avoid causing further damage to an already fragile cornea.
Some people have normal corneas prior to surgery, but either because the cataract surgery takes too long, or there are complications during the surgery, or the postoperative care of the cornea is not optimal, corneal swelling or "edema" can persist for months after
cataract surgery and prevent recovery of vision. In some cases corneal transplant surgery may become necessary after your cataract surgery.
If you have prolonged corneal edema, swelling or cloudiness after your cataract surgery, or if you've had or been told that you need a corneal transplant after cataract surgery, there is a possibility that the appropriate measures were not taken to protect your cornea during the cataract surgery, or treat it properly after the surgery. To determine if malpractice is the cause of your cornea problems an expert review of all of your surgeon's medical records is required.
During cataract surgery the surgeon has to dilate the pupil with eye drops prior to the surgery, and occasionally with special instruments during the surgery. As a result, occasionally the pupil may be slighly altered in size, shape or reactivity. Rarely, the
pupil may be permanently damaged during surgery leaving it permanently too large, or very irregular in shape. This may cause you to have permanent glare and haloes from lights, and occasionally, severe, permanent light sensitivity which may prevent night-time driving and other activities during sunlight.
To determine if your pupil problem was the result of reasonable surgical manipulations, or malpractice, the surgeon's office records and operative report from the surgical facility must be evaluated by an expert.
A cataract is the lens of the eye that has become cloudy. When the cataract is removed during surgery it is almost always replaced by a new, crystal clear, plastic lens (called an IOL) that is inserted inside the eye at the same time. The best type of IOL is called a
PC-IOL, or posterior chamber IOL. It sits behind the iris and pupil in the part of the eye called the "posterior capsular bag."
Occasionally, problems develop during surgery which prevent the surgeon from placing the PC-IOL in the ideal spot, and instead it is placed in the "ciliary sulcus," or sutured to the iris with stitches. When that occurs, the eye is more susceptible to inflammation and other problems postoperatively which may cause short or long term delay in recovery of vision, and other complications that may require additional surgery to correct. Rarely, the PC-IOL may fall into the back of the eye, into the vitreous or retina, and require additional surgery to remove or reposition.
On rare occasions, complications occur during surgery which prevent a PC-IOL from being used, and instead the surgeon uses an anterior chamber IOL, or AC-IOL. This sits in front of the pupil and iris. AC-IOLs have a significant greater risk of causing long term complications of various types after cataract surgery such as glaucoma, iritis (inflammation), corneal swelling and cloudiness, and pupil irregularities. They can also cause a chronic mild to moderate eye pain that persists indefinitely.
Prior to cataract surgery the surgeon must take precise calculations of the size of the eye and curvature of the cornea to determine what power the IOL should be that is used during the surgery. Each eye must have a customized IOL and power to give you the best
possible vision after surgery. In most cases, the IOL power and the expected vision should be discussed with you prior to surgery tomake sure that the IOL will be suitable for your vision needs, life style and work activities. Additionally, the surgeon must try to balance the IOL power with the prescription of the other eye. This balancing should also be discussed prior to surgery. If the correct IOL power is not used then you may have problems such as double vision, difficulty with reading and computer use, and trouble
driving. An incorrect IOL power may require additional IOL surgery or corneal laser surgery to correct, which can exposes the eye to additional risks.
Very rarely, the surgeon may choose the correct IOL power prior to surgery, but in the operating room mistakenly insert the wrong IOL into your eye. This often requires additional IOL surgery or corneal laser surgery to correct, which may expose the eye to additional risks. If you have had an IOL complication as described above, a detailed review of your surgeon's and surgical facility's medical records by an expert is essential to determine if your problems are due to malpractice.
In the last decade two new categories of IOLs have become available. They are both also PC-IOLs but they have enhanced optical properties. The first type is known as a multifocal, bifocal or accomodative IOL (MBA-IOL) and the second type is a Toric IOL.
The traditional PC-IOL that has been used for decades provides either distance vision or near vision -- but not both -- depending on the power of the lens that the surgeon picked with your approval. If you picked a distance vision IOL, then you should have very good
distance vision after surgery without glasses, or with minimal distance prescription glasses. But, you will definitely need reading and computer glasses. If you picked a near vision IOL, then you should be able to read and use a computer without glasses, but will
need glasses for distance vision such as driving or watching TV.
MBA IOLs provide both distance and near vision in one IOL, so in most cases you don't need distance or near glasses in the eye that had the surgery.
Not every eye is a good candidate for an MBA IOL. If your eye is not a good candidate but received one during surgery, then at best you won't be able to reduce your dependence on glasses, and at worst you may have significant glare, haloes and double vision in the
eye with the MBA IOL. This may require additional surgery to remove the MBA IOL and replace it with a standard PC-IOL. That exposes your eye to additional risks and complications. Occasionally, the wrong power MBA IOL is used during surgery. This is discussed in the section above on "Intraocular lens (IOL) complications."
A Toric IOL is an optically enahnced PC IOL that corrects pre-existing astigmatism in the eye that was there prior to cataract surgery. The benefit of this is that it provides significantly improved quality of vision after cataract surgery, with less dependence on distance glasses, and simpler reading and computer glasses. Placement of a toric IOL during surgery requires proficiency with the proper technique to accomplish this.
Not all eyes are good candidates for toric IOLs. If you're not a good candidate and received a toric IOL during cataract surgery, then at best you won't be able to reduce your dependence on glasses, and at worst you may have significant glare, haloes and double
vision in the eye with the Toric IOL. This may require additional surgery to remove the Toric IOL and replace it with a standard PC-IOL. That exposes your eye to additional risks and complications. Occasionally, the wrong power Toric IOL is used during surgery. This is discussed in the section above on "Intraocular lens (IOL) complications."
Rarely, a Toric IOL is not positioned properly during cataract surgery, which therefore does not reduce astigmatism and occasionally increases your astigmatism. This complication would require additional surgery, with its risks, to reposition the Toric IOL inside the eye. Not all surgeons have mastered the special preoperative steps and surgical techniques for using MBA and Toric IOLs, and therefore do not offer this option to their patients. If you were a good candidate for an MBA or Toric IOL and were not given an option to receive one during surgery, then you may be missing some visual benefits and optical enhancements of those IOLs.
If you have any of the new generation IOL problems discussed above, you need to have an expert review of all of your ophthalmic medical records to determine if any malpractice was committed.
Cataract surgery, which is done in the front part of the eye (anterior segment) can put mechanical or inflammatory stress on the vitreous fluid, retina, and macula (center and most important part of the retina). This may result in a condition known as CME (cystoid macular edema), which is a swelling or thickening of the center of the retina known as the macula. CME can cause long term blurry, cloudy and hazy vision in the eye that had surgery. Fortunately there are effective ways, with eye drops usually, to prevent and treat CME. If it is not treated properly it can result in permanent retina/macula damage and permanent reduction in vision.
A small percentage of eyes that have had cataract surgery can develop retinal tears, holes or detachments at any time after cataract surgery. That is especially more common if the cataract surgery had problems with positioning or placement of an IOL, or if an "anterior vitrectomy" surgery was done in addition, at the time of the cataract surgery. Retinal tears, holes or detachments require prompt laser treatment or surgery of the retina to prevent permanent loss of vision. Some eyes have pre-existing conditions that expose them to additional risk of retinal tears or detachment. These eyes soemtimes require laser pre-treatment before cataract surgery, and more careful monitoring after cataract surgery in order to find and treat minor retina problems before they become major complications.
Symptoms such as seeing spots, floaters or flashes of light may be signs of a retinal tear, hole or detachment. If you have a cloud or loss of your peripheral or side vision, that may be a sign of a worsening retinal detachment. These symptoms should be immediately
reported and promptly and thoroughly evaluated by your surgeon. Failure to promptly diagnose and treat a retinal tear, hole and detachment can lead to severe, permanent loss of vision.
If you have had any vitreous, retina or macular complications after cataract surgery, an expert review of your ophthalmologist's records is required to determine if your problems were caused by malpractice.
If you have BPH (benign prostatic hypertrophy) or an enlarged prostate, and are taking or have taken in the past any of these alpha-blocker medications: flomax, tamsulosin, terazosin (formerly Hytrin), doxazosin (Cardura), alfuzosin (Uroxatral) and silodosin (Rapaflo), then you are at risk of developing "floppy iris syndrome" during cataract surgery. Floppy iris syndrome prevents adequate pupil dilation, may cause the iris to come out of the eye during surgery, and makes removal of the cataract more difficult. The surgeon must be prepared to deal with all these problems suddenly during the surgery to prevent long term serious complications and problems postoperatively. Knowing that a patient is, or has been on these medications is the first step for the surgeon in being prepared to make instantaneous surgical modifications.
If you've had a an alpha-blocker-related cataract surgery complication, then an expert review of your ophthalmologist's office and surgical records are required to rule out malpractice.
Many people who have had significant loss of vision, loss of an eye or pain due to complications after cataract surgery are chronically depressed and develop relationship problems with their spouse, significant others and family. It's common for these people to require chronic anti-depressant or mood elevating medications, and be under the chronic care of a psychiatrist, psychologist or other mental health professional. Some people cannot work and stop enjoying life due to these problems.
An expert review of your medical records is required to determine if your mental health problems are related to malpractice during or after cataract surgery.
If you've lost your job, or have experienced a diminished ability to generate income, or can not work as a result of cataract surgery malpractice, you may be entitled to immediate and long term compensation.
Additionally, if you have large medical bills as a result of cataract surgery malpractice, you may be entitled to financial compensation for those bills and expenses.
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