One complication that does arise in probably less than 3% of the cases is what is called a posterior capsular tear.
Cataract Surgery Malpractice-Capsular Tear
That tear can arise for any of a number of reasons. Most often it arises because the surgeon has probed with the emulsification instrument too far back into the capsule area and may have poked a hole in the capsule.
See the other post on this site for the anatomy of the eye to better understand how cataract surgery is done.
Cataract Surgery Malpractice-The Surgical Procedure
The basic method of cataract surgery is first to use a laser instrument to “score” the lens. The lens itself is comprised of nuclear material which is very hard. That nuclear material is at the center of the lens. Outside of the nuclear material is cortical material which tends to be of a type of “gummy bear” consistency. The portion of the lens that is scored is the nuclear part which is quite hard. By scoring it, the physician is attempting to crack it or break it into pieces. They may break it into 4, 6 or more pieces, depending on their particular preference.
Once that has been done and once a hole has been cut into the front of the capsule, then the surgeon goes into the capsule where the lens is contained and breaks it up further. The surgeon chops it up and sucks it out.
The Goal
The goal is to be able to remove as much of the lens as possible and then to put the new artificial lens through that surgical hole that was cut in the front of the capsule and put it into the capsule.
Once that is completed, then the surgery is essentially done.
If a hole develops in the back of the capsule, towards the back of the eye, that is a complication that can become very troublesome. That hole in the back of the capsule allows the vitreous which is behind the capsule to enter into the anterior part of the eye. It also potentially allows lens material to get into the back of the eye into the vitreous.
That vitreous is sticky and stringy. Any foreign substance in the vitreous area is probably going to cause inflammation which results in swelling and increased intraocular pressure. Increased pressure is dangerous for the back of the eye. The optic nerve may be damaged as a result of that increased pressure.
Cataract Surgery Malpractice-Retained Lens Material
Any physician who is confronted with a tear in the back of the capsule needs to be mindful of the fact that not only may the vitreous come into the front of the eye, but the broken-up lens material may float back into the vitreous area. It can cause a number of complications.
From a safety point-of-view, it is probably a good idea for an anterior segment surgeon who is doing cataract surgery to have nearby, a retina specialist. That physician can come in and take a look at the back of the eye if there is any fear that lens material got into the back of the eye.
If any significant amount of lens material got into the back of the eye, then the patient is probably going to have post-surgical symptoms. These may include but not be limited to increased intraocular pressure, pain, a feeling that something is in the back of the eye. There may also be decreased vision, a hazy cornea caused by the inflammation in the back of the eye and other symptoms. Those symptoms are not necessarily indicative of there being lens material in the back of the eye. However they may indicate such.
Intraocular Pressure
Because of the sensitive structures in the back of the eye including the optic nerve and the retina, it is probably a good idea for an anterior segment surgeon who has had this complication to have a posterior segment surgeon, a retina specialist, take a look at the eye. The retina specialists are very much attuned to examining the back of the eye. If for any reason they can’t get a clear view visually of the back of the eye then they can use an ultrasound instrument known as a B-scan. This will tell them whether or not there is lens material in the back of the eye. Also it will tell them whether or not there is a retina tear or whether there is a retinal detachment.
A retinal tear is not a happy occasion. However if that retinal tear is dealt with promptly, then it can be repaired and reattached before there is any significant damage to the retina.
Cataract Surgery Malpractice-A Clear View
The primary area of negligence for a cataract surgeon is the inability to get a clear view of the back of the eye after recognizing that there is a tear in the back of the capsule. If the surgeon cannot get such a clear view, then there ought to be an immediate referral to the retina specialist who will be able to get a clear view. That retinal specialist will properly manage any tear or detachment that may have begun. That referral probably should be either on the surgical day or on the next day. It is then up to the retina specialist to make a decision as to whether or not there is a need for removal of the lens material and a need to go in and repair any tears or detachment.
The failure to make that referral prevents the patient from being properly managed by a retina specialist.
Call, or contact us for a free consult. Also for more info on malpractice see the Wikipedia pages. Also see the post on this site dealing with eye injury issues.
