Negligent Administration of Ophthalmic Anesthesia Causes Permanent Loss of Vision

    cataract surgery expert witnessThis visual impairment case involves an elderly woman who suffered serious complications following a routine cataract surgery. The procedure, which entailed the placement of an intraocular lens implant, was performed on an outpatient basis. After the operation, the patient complained of blurry vision, pain, and headaches. In addition, the postoperative evaluation by the operating physician demonstrated a retinal detachment, and the patient was referred to a specialist. During the specialist’s examination, he discovered significant retinal scarring and attributed the cause to the placement of the anesthetic needle used during the patient’s cataract repair surgery. As a result of this scarring, the patient continues to experience reduced visual acuity in the affected eye.

    Question(s) For Expert Witness

    • 1. Do you routinely administer ophthalmic anesthesia to patients like the one described above?
    • 2. Have you ever had a patient develop the complications noted?

    Expert Witness Response E-002863

    I assume that a retrobulbar block with local anesthetic was performed by the anesthesiologist in this case, although this is not stated explicitly. I also assume, based on the case summary, that a complication of the retrobulbar block occurred. I assume that the patient consented to having an anesthesiologist place a retrobulbar block and was aware of the possible complications and rate of complications. There is, albeit, a low incidence of complications from retrobulbar blocks. I do not perform these routinely at my place of work (I was trained to do them but do not routinely perform them; although they are relatively easy and quick to perform.) Frankly, it seems excessive to perform a retrobulbar block for cataract surgery, as in my experience the greatest majority of cataract surgery is done under local anesthesia with sedation (sedation with or without an anesthesiologist, or Certified Registered Nurse Anesthetists supervised by anesthesiologists). I routinely supervise CRNAs for sedation and general anesthesia for eye cases; I have never had a complication like the one described.

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