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Ophthalmology: the good, the bad and the ugly

This article describes procedures and common complications relating to some aspects of eye surgery. Most ophthalmic claims divide into three groups: the first, where the surgery and general care of the patient is not at fault but the patient is dissatisfied with the result or simply dislikes the surgeon; the second is where substandard care and clinical negligence has occurred and the patient has had a bad result; and the third is where a surgical disaster has occurred. Medicolegal issues in cataract surgery often concern the preoperative consenting and counselling process, when an individual claims not to have been warned about a particular complication when the result is not as good as the patient expects. Vitreoretinal procedures for retinal detachments and macular disease do not attain the same excellent surgical outcomes as cataract surgery, though patient expectation is often as high. Common cases in this group involve chronic retinal detachments that have blinded an eye over several months and not been diagnosed by an optician. Another recurring theme is the negligent use of intraocular gas where an unintended expansile volume is injected into the eye or if the patient is not warned about high altitudes or the effect of anaesthetic gases that make the bubble expand in the eye to cause a very high pressure with excrutiating pain and blindness from occlusion of the central retinal artery. Ocular trauma cases often centre on inadequacies of ocular protection, the lack of prophylactic antibiotic cover and not warning patients about sympathetic ophthalmia after penetrating ocular injuries.