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Making cataract surgery safe

Posted: 12/09/2019

Surely every patient wishes to know that he or she will leave hospital in better health than when the consent form was signed. The surgeon will also want to be able to assist the patient as efficiently as possible and to manage their expectations appropriately.

As surgical procedures so often result in one problem being replaced by another, it is not surprising that research has been taking place to see if the process can be handled better. That research was reviewed in a paper entitled Routine preoperative medical testing for cataract surgery (Cochrane database syst rev 2019).

The paper brought together the results of three randomised controlled trials of a large cohort of patients scheduled to have surgery for cataract due to age. The trials were conducted in the USA, Brazil and Italy.

Patients underwent routine non-specific testing (electrocardiology for heart function, full blood count and the various serum tests to identify any disease markers). The control groups had no tests unless they had some pre-existing diagnosed concurrent illness.

Surprisingly the results showed that the risk of adverse medical events occurring in the procedures was not reduced by such screening.

The studies also looked at comparing specific injuries to the eyes in these two scenarios. Again there was evidence in only one of the studies that there was a small adverse effect. The notable difference however was that there was a more than twofold increase in the costs of surgery with comprehensive preoperative testing. That meant that, in practice, such testing would normally only be carried out in the private sector.

It is thought that one reason to carry out such testing is to protect clinicians in a medico-legal context. Of course the testing itself may cause harm and, in the context of this paper, unnecessary harm.

A commentary in the Eye journal noted that of more importance in surgery of this type are operative complications and poor outcomes.

A major complication factor is posterior capsule rupture with or without vitreous loss which may lead to infection and/or retinal detachment. Preoperative testing does not help to identify such cases.

However there is evidence that risk assessment and scoring help to identify those who are particularly vulnerable so that they can receive the most suitable care from the most appropriately experienced specialist.

This process is designed to address the relative likelihood and possible consequences of such complications. When looking at risk, unsatisfactory outcomes can also be considered – an obvious example might be insufficient attention being given to intraocular lens choice leading to unsatisfactory post-operative refractive errors. The ophthalmologist would be wise to use a risk assessment tool and record its findings.

Tim Wright, a senior associate in the clinical negligence team at Penningtons Manches Cooper, said: β€œIn managing claims on behalf of clients who have suffered ophthalmic injury in surgery, one aspect that we will always be looking for will be evidence of a formal surgical plan and risk assessment.”

If you have suffered an injury to one or both of your eyes following cataract surgery and you are concerned about your treatment, our specialist clinical negligence solicitors will be able to provide you with advice on your options.

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