Endophthalmitis – infection inside the eye is a common complication requiring early recognition, and immediate referral to a retina specialist. Failure to refer out patients with pain and/or decreased vision up to 10 days after surgery is a departure often resulting in significant vision loss.
Dropped Nucleus – the central dense part of cataract may drop into the vitreous during cataract extraction after the posterior capsule breaks absent negligence. Failure to promptly recognize and refer to a retina surgeon quickly within 2 weeks, usually sooner, constitutes malpractice. Delay can lead to a host of complications including retinal detachment, glaucoma, and cystoid macular edema, among others.
Intra-Ocular Lens Issues – IOLs are almost always placed after the cataract is removed in order to restore the focusing power of the eye. The implant’s power is calculated based on measurements taken of the eye prior to surgery. Miscalculations can occur; failure to recognize and address promptly is a deviation. The IOL can also be implanted negligently which can lead to displacement and visual disturbances. The improper IOL choice in a particular patient (material, style, other characteristics) can also be a departure.
Corneal Edema – there is almost always some swelling of the cornea associated with the trauma of the surgery. Excessive trauma, length of surgery, or inadequate aggressiveness in treating with steroids post-operatively can necessitate a corneal transplant and constitute negligence.
Retinal Detachment – occurs more frequently after cataract surgery in some patients (especially if nearsighted). Legal issues may includeinformed consent in a myope and timely recognition. It is imperative that a “dilated exam” be performed on that visit if symptoms of retinal pathology (typically flashes/floater, veil over vision) are present. The results of R.D. repair are highly dependent on the length and extent of the detachment.
Informed Consent Issues – patients need to be informed of certain pre-existing conditions that increase the risks of surgery such as glaucoma, previous R.D, diabetes, high myopia or hyperopia, corneal edema (Fuch’s dystrophy), and use of Flomax (or equivalent).