CATARACT SURGERY

When an operation to improve vision results in blindness the question of medical negligence is often raised.

Damage to the gossamer-thin posterior capsule of the lens occurs with low but predictable frequency even in the most experienced surgical hands[1]. The jelly-like vitreous which fills the bulk of the eye behind the lens can now escape into the front of the eye, blocking circulation of fluid and causing glaucoma and other potentially damaging complications. Vitrectomy (removal of vitreous) is designed to prevent or limit such damage, and is routinely undertaken when the posterior capsule is breached[2].

Much less commonly, but more frequently after posterior capsule damage, endophthalmitis, a devastating infection of the inside of eye, complicates cataract surgery[3], [4]. Again, its occurrence is not of itself evidence of substandard surgical technique.

PRACTICE POINT Potentially devastating complications of cataract surgery occur in the most experienced hands: delays in their prompt recognition and vigorous treatment may be actionable.

What may be found negligent is subsequent delay in diagnosis and treatment of glaucoma and particularly endophthalmitis[5]. Both these complications require prompt and vigorous treatment, the outcome of which is generally good. Insufficient postoperative instructions or inadequate emergency follow-up arrangements are more likely the culpable factors than substandard diagnostic acumen or inadequate treatment, since diagnosis and management are well-standardised.

Astigmatism may be worsened, or may appear for the first time following cataract surgery⁶.  Highly myopic (short-sighted) eyes are more susceptible to postoperative astigmatism, particularly if a larger intraocular lens (and hence a larger incision) is required.  This complication can be controlled intra-operatively⁷ corrected by corneal laser surgery⁶ pre-operatively or postoperatively, and intra-operative correction⁸ is in process of development. 

Retinal detachment is more common after cataract surgery. 

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