A forensic ophthalmology expert is often sought to render opinions regarding issues of standard of care in cases that involve retained lens fragments. This well-known complication of cataract surgery can occur when the posterior capsule ruptures at the time of cataract surgery, allowing portions of the cataract to migrate through the rupture and into the posterior segment of the eye.
Retained lens fragments may occur in certain high-risk situations. For example, Pseudoexfoliation of the lens is considered a high-risk situation that may predispose to complicated cataract surgery, including retained lens material. In pseudoexfoliation there may be weakness of the zonules that normally stabilize the lens capsule in its proper position. Patients who have a dislocated cataract are also considered high-risk because of the same reason.
Many studies show that in many cases a favorable visual outcome may still be obtained if lens fragments are removed by timely referral to a retina specialist. Appropriate management at the time of surgery and during the postoperative period are important factors when assessing questions of possible negligence.
A multitude of problems may be associated with retained lens material. These problems may contribute to a poor visual outcome. The most common complications include elevation of intraocular pressure leading to glaucoma, edema of the cornea, edema of the retina, and inflammation inside the eye. Under unusual circumstances, patients with retained lens material may also develop infections, intraocular hemorrhage, epiretinal membrane formation, or retinal detachment.
Retained lens material may be managed by the operating surgeon, but in many cases the surgeon will refer the patient to a cornea, glaucoma, or retina specialist. A subspecialist may decide to perform additional procedures such as a pars plana vitrectomy, a procedure to reduce intraocular pressure, or repair of a retinal detachment.
A forensic ophthalmology expert reviews medical records, depositions, operative reports, operating room records, allegations, and other pertinent evidence to arrive at opinions. An expert may be called on to explain the rationale for his opinions in deposition or at trial. The largest group of claims for retained lens material with cataract surgery is related to patients who have poor visual outcomes. However, patients who have good visual outcomes are also known to bring actions against the operating surgeon. Cases with retained lens material usually require diligent follow-up and timely referral to a subspecialist when indicated.
Although cataract surgery is considered safe and effective when performed properly for an appropriate candidate, complications can occur in the absence of negligence. A review of specific cases by a qualified forensic ophthalmology expert may assess allegations of negligence and damages.
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