Opthalmic surgical errors

Opthalmology procedures that give rise to errors

Cataracts

A cataract impedes light getting from one side of the lens to the other and become more likely as a person ages. Cataract surgery is primarily carried out by phacoemulsification (phaco).

A recognised complication of this procedure is phaco burn. This can occur if the phaco probe tip gets too hot during the procedure. It is imperative that if this occurs it is the duty of the physician to repair and treat the burn intra-operatively.

Another aspect of cataract surgery is the failure of the doctor to recognize and/or treat signs of symptoms that present during post-operative examinations or visits.

Retinal tears and detachments

If retinal detachment isn’t treated or diagnosed in a timely manner, blindness can occur. The most common type of detachment is a rhegmatogenous detachment. This is where fluid seeps into a hole or tear in the retina causing the neurosensory retina to be pulled away from the retinal pigment which causes it to be ‘detached’.

Certain risk factors predispose patients to retinal detachments and tears including severe myopia (near-sightedness) and cataract surgery. Doctors need to be particularly wary of patients presenting with these conditions.

If a retinal tear is diagnosed it can be treated by photocoagulation (laser) or cryopexy (freezing) to prevent the tear/hole from becoming a detachment.

However, surgery is required once the retina detaches. The three surgeries that are used are:

• Scleral buckle
• Pars plana vitrectomy
• Pneumatic retinopexy

Refractive surgery

This is any surgical procedure that permanently alters the focusing power of the eye in order to change refractive errors (such as near-sightedness, farsightedness and astigmatism.)
A malpractice case is rare in these procedures but may arise from the doctor performing refractive surgery on a patient that is not a candidate due to a pre-existing corneal condition. The failure to evaluate or screen patients properly can lead to very debilitating and permanent injuries.

A study published by The Archives of Opthamology (November 2007) stated that the most common errors that occur in opthalmic surgery include operating on the wrong eye, blocking the wrong eye with anaesthesia and implanting the wrong IOL( intraocular lenses used in cataract surgery).

“Although they usually cause little or no permanent injury, consequences for the patient, doctor and the profession may be serious.”

The study reviewed 106 cases of surgical confusion in opthamology. These cases occurred between 1982 and 2005. Errors were categorized into 5 main areas of error:

• Wrong eye block
• Wrong implant
• Wrong patient/procedure
• Wrong eye
• Wrong transplant

Each error was also rated on a severity scale ranging from one (temporary/insignificant) to four (severe permanent injury/uncorrectable vision loss).

The most common error in this study was implantation of a wrong IOL.

“The cause in almost every (intra-operative) case was failure to check the lens specifications properly before implantation.”

Two patients in the study who had the wrong IOL implanted developed corneal edema, while glaucoma occurred in another patient, who required a drainage implant and a final visual acuity of 20/40 with visual field loss.

In 13% of cases (14 patients) anaesthesia was injected into the wrong eye, where most cases lacked a site marking to indicate the correct eye for the procedure.

Fourteeen cases received a high severity score of three or four. Many of these errors led the medical institutions involved to revise their policies regarding site marking or to update other steps usually taken to prevent error.