78-year-old male with pre-existing severe pseudoexfoliation glaucoma (PXE) OD (CDR 0.8) on triple-agent medical therapy, underwent cataract extraction with IOL OD by Dr. Shalesh Kaushal on November 25, 2024. The surgery was complicated by intraoperative zonular failure/posterior capsule rupture requiring placement of an anterior chamber IOL (AC IOL) and an unplanned pars plana vitrectomy (PPV) — both hallmark high-risk complications of PXE cataract surgery. Over the following 64 days and 10 post-operative visits with Dr. Kaushal, a developing retinal detachment with multiple breaks went undiagnosed. The patient self-referred to a different retina specialist (Dr. Claudio Ferreira) on February 18, 2025, where the detachment was immediately identified and emergently repaired the same day. By then, the detachment was "semi-chronic" with a duration of approximately 2–3 months. The patient's right eye vision is now reduced to hand motion / light perception, with optic nerve cupping progression to CDR 0.90 with disc pallor — permanent, near-total functional blindness in the right eye.
Potential deviations include:
1. Deficient Operative Note which didn’t contain any clinical content. Note: We do not have the 11/25/24 operative report. No subsequent treaters could find the operative note either so perhaps it doesn’t exist.
2. F/T diagnose a retinal detachment across 10 postoperative visits
3. Inadequate quality of postoperative retinal examination in a high=risk post-PPV patient
4. Instruction to discontinue all glaucoma medications
5. Deficient informed consent
Files:
Q: Are you saying that the cataract surgeon performed a pars plana vitrectomy (PPV) on the day of cataract surgery? most often, cataract surgeons will perform a limited anterior vitrectomy in this setting.
A: —
Do you believe there might have been medical error?
Was patient complaining? Was patient dilated after cataract done?
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
Failure to diagnose and treat in high risk post op patient
What makes you a good expert for this case?
Been doing this a long time both defense and ain't iffy Please check my cv
How often do you encounter cases similar to this one in your practice?
Frequently Have seen similar cases like this
Do you believe there might have been medical error?
I would need the complete records but a dilated exam should have been done revealing the RD at some point.
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
RD can happen even in a case where nothing went wrong. Early pickup leads to better outcome though.
What makes you a good expert for this case?
Cataract surgeon with 21 yrs experience.
How often do you encounter cases similar to this one in your practice?
Thankfully rarely, but did pick up one postop retinal tear and one RD. Both immediately referred by me to retina with good outcome thankfully. This can happen in any situation to anyone, but early diagnosis and referral is important for best chance at a good outcome.
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