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Dr. Tom
Dr. Tom, Board Certified MD
Category: Eye
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Experience:  30 years experience treating patients with eye problems
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I had surgery as a result of a retina detachment. During examination

Customer Question

I had surgery as a result of a retina detachment. During examination the surgeon stated he would be using laser and gas. At surgery he decided to remove the lense using a 22 gauge vitrectomy. He said, the lense kept getting stuck on the edge, caused bleeding. He ended the operation by putting liquid in. 2 weeks later I had an operation to remove liquid and insert oil and a third operation to remove the oil. I had a blood clot and the carnea scarred and no lense. The pupil is distorted and I am in constant pain at a level of 2-3. The lense he said was a residual lense left over as a result of an accident I had when I was a kid. The lense kept the pupil intact. Is the surgeon negligent? He said a 20 Gauge equipment is stronger and better to use however, he did not have it at surgery. Also, removing the lense without my consent. He used extensive laser treatment during all three surgeries. The retina is attached. Please help! Kind regards Paul

Submitted: 1 year ago.
Category: Eye
Expert:  Dr. Tom replied 1 year ago.

Dr. Tom :

Hi, I'm online now and would be happy to help you with your question.I understand what you are asking. Just reply and we'll get started. Dr. Tom

Dr. Tom :

Dear XXXXX,....I am so sorry that you are having so much eye trouble. I will be happy to give you answers to your question. It would help me to better understand, if you would tell me the status of your recently operated eye prior to the retinal detachment. Was it a normally seeing eye, or was your vision bad from your childhood injury?........Since you are offline now, please just post a quick answer. I will check back in to see if you are available to chat...or if you are busy now, tell me a time that you can be on line and I will try to work on your schedule.

Expert:  Dr. Tom replied 1 year ago.

Please send an email so we can work together on your question. Thanks

Expert:  Dr. Tom replied 1 year ago.

Dear XXXXX,

I'm sending a follow-up email to see if you would still like to discuss the question you posted about your retinal detachment surgery. Just let me know when you'd like to chat.

Customer: replied 1 year ago.


Hi Dr. Tom,


 


Yes, I would like to chat.


 


I am available everyday at the same time as now for around 2-3 hours


Regards


Paul

Expert:  Dr. Tom replied 1 year ago.
Hi Paul, are you available right now?
Expert:  Dr. Tom replied 1 year ago.
If you are available, would you please let me know the status of your recently operated eye prior to the retinal detachment. Was it a normally seeing eye, or was your vision bad from your childhood injury?........
Expert:  Dr. Tom replied 1 year ago.

Hi again Paul,

Since we don't seem to be able to hook up online at the same time, I would like to give you some thoughts regarding your question, even though it would be ideal to have had a little more information. Based on the way your posting described your eye problem and conversations with your ophthalmologist, it sounds as though, because of a childhood injury you had scarring in the anterior segment of your eye. This could have resulted in a traumatic cataract with scarring of the pupil that was difficult to evaluate at the time that your retinal surgeon and you made the decision that repair of your retinal detachment was appropriate. This easily explains the difficulty that was encountered as you surgeon was repairing your detachment. And is is reasonable that he needed to remove the old tramatized len of your eye. Even though this was not specifically discussed before surgery, it's the standard of care for the surgeon to make appropriate decisions for the well being of your eye at the time of surgery. There would not be negligence regarding that decision.

In your posting, you stated a number of things, but your only specific question was "Is the surgeon negligent?" I hope my answer cleared up that question.

Then you stated that your surgeon used 22 guage. Both 20 ga and 22 guage are considered appropriate standard of care instruments.

So given the information I have provided so far, I will be happy to address any specific question you have after you have read this.

I will be standing by.

Customer: replied 1 year ago.


How do we hook up?

Expert:  Dr. Tom replied 1 year ago.
We are hooked now.......let me know what I can answer now that you have read my reply?
Expert:  Dr. Tom replied 1 year ago.
Please let me know if you are getting these emails?
Customer: replied 1 year ago.

Unable to view my post to you!


 

Expert:  Dr. Tom replied 1 year ago.
Hi Paul...I did not get your post either...please type any follow up question in the box below.....and please tell me if my answers so far have helped you?
Customer: replied 1 year ago.


Ok. Please allow a few minutes.

Expert:  Dr. Tom replied 1 year ago.
Sure...take your time.
Customer: replied 1 year ago.


I have to retype it now.


 

Expert:  Dr. Tom replied 1 year ago.

Hi again Paul,

Since we have been trying to chat since about 6:30 PM , I'm going to have to sign off duty for tonight and check back in tomorrow to see if you replied to my response to your question. I really want to be helpful to you......we just need to keep a dialog going for this to be beneficial to you.

Customer: replied 1 year ago.

Sorry for the delay. I had to retype it. I am hoping to provide you with the info.

Ok.

You stated it was reasonable the surgeon to remove the residual matter at the time of surgery. However, in doing so caused problems. Was the surgeon negligent in the procedure in removing the residual matter???

 

A pre-examination should determine the residual lens to be removed and the procedure required. Also, consent was not given to remove the lens.

 

I did not want the lens to be removed. The lens kept the pupil intact and made the appearance of the eye, similar to my good eye. Now, the pupil is distorted, looks different to my good eye, no lens, very sensitive to light and constant pain. Constant inflammation and redness in my eye and throbbing and twitching. Furthermore, I am unable to make eye to eye contact with people fearing they would notice my eye.

 

The surgeon afterwards agreed he should have left the lens.

 

My vision was bad as a result of my childhood injury, when I was about 7. My level of vision is probably the same.

 

According to the Doctor, he stated during surgery I had a residual lens attached to it under the pupil and getting in the way of the view. So he decided to remove it. He said in a traditional vitrectomy you can pull it out but with 22 gauge you can’t.

 

I was awake during surgery. A local was used.

 

He started by repairing the retina, using laser and then gas. I remember feeling something cold in my eye. I am thinking it is the gas. Please confirm. I believe that part went very quickly. Please provide an estimate of time to complete.

 

Then I believe, he decided to remove the lens.

 

He said he opened the port bigger to take residual matter out. He said the lens kept getting stuck on the edge of the wound. Because the hole was bigger a lot of fluid started to come out and bleeding from the wound.

 

He was inserting a tool in and out of my eye. I clearly recall as he would in a quick motion insert the tool and pull it out. He was doing this on both ends of my eye. This resulted in about 7 stitches ( I am assuming there should have been no stitches if he had decided not to remove the lens). I felt he was rushed. He was working quickly. I heard him say he dropped the lens.

 

The operation went on for a long time. So he decided to end the operation to let everything stabilise. He put liquid in the eye.

 

Next day, he examined me. He said there is a clot on the pupil and he couldn't see in because of the liquid. He said that a 20 gauge tool is stronger to use.

 

Two weeks later I had another operation to remove the liquid. I don’t know what else he did. He put oil. Three months later I had surgery to remove the oil. The retina is reattached. However, I have been in pain since the first surgery happened in Feb, 2010. The pain level is constant between 2 to 5 out of 10. I have seen numerous other Doctors unable to help. Currently, I am managing my pain taking all precautions to avoid irritating my eye, such as avoiding sunlight (Interestingly, in my recent blood test, my vit D level was low). I control my pain with pain killers when the pain level reaches about 5.

 

If the operation was successful, I would think no stitches required. He would have been able to remove the lens matter, no bleeding. Use laser with gas and no liquid or oil and no further operations. Is that right? I believe the decision to remove the lens resulted in my problems.

 

Another doctor examined me. He said anterior segment showed that there is evidence of the fine emulsified oil droplets in the aphakic left eye. Few droplets of trapped silicone oil in the conjunctiva temporally and the nasal sclerostomy looks a little bit inflamed and thinned. The oil droplets may give high intraocular pressure and uveitis to explain the pain.

 

Also some ocular surface pain and mild ongoing inflammation leading to long term pain. The ocular is no longer smooth. There is a corneal scar just inferior to the visual axis.

 

Ok. You stated the equipment used was appropriate, the decision to remove the lens was reasonalble and it is understandable for failing to evaluate the residual matter in my eye.

 

However, a reasonable outcome for me was to remove the residual matter, repair the retina and use of gas and no further operations.

 

I look forward to your reply.

 

Thank you for your support.

I live in Australia. I would be willing to travel to US for treatment.

 

Kind regards

Paul

 

 

 

 

 

Expert:  Dr. Tom replied 1 year ago.



Hi Paul,

 

I've prepared a lengthy answer for you, but I will wait until we can get in sync with our on line time together.

 

Now that I know you are in Australia ( I am on the east US coast) it's easy to understand why we are having trouble getting together.

Customer: replied 1 year ago.


Hi, r u available to sync now?

Expert:  Dr. Tom replied 1 year ago.

Hi Paul,

Could we meet at 8 AM EST ?

Customer: replied 1 year ago.


I can meet you about 12pm.

Expert:  Dr. Tom replied 1 year ago.
Paul, let's shoot for 3PM, as we won't be home from church until then, Would that suit you?
Expert:  Dr. Tom replied 1 year ago.


Dear XXXXX,

Since we've been having trouble getting together online I feel like I owe you an answer, and even though I would perfer to be together on line so I can respond to you, I'll go ahead and reply now.



I've read over your last posting several times, trying to

determine what is the best way to give you useful advice. I've even made a
telephone

call to one of my retina colleagues, and I'll mention that a little further

along in this reply.





It is clear that you are disappointed, and that you have had

a difficult course of treatment. It also sounds like you have had appropriate,

though difficult, management of a complicated situation. First, we must not

lose sight of the fact that you developed a retinal detachment which had to be
repaired

to prevent further long-term complications in your eye. The objective was

accomplished, but you now have pain and an unacceptable cosmetic iris/pupil.

(By the way, there are cosmetic procedures, usually surgical, that can be used

to reconstruct your iris and pupil, so that it appears more normal). And you

can have confidence that you will eventually develop a quiet, non-painful eye.

You mentioned that you were concerned that the necessity to use sutures was an

indication of a mishap. Retina surgeons frequently use sutures to close their

vitrectomy ports, so the use of sutures could certainly have been indicated in

your case.





In your posting you said, "The

oil droplets may give high intraocular pressure and uveitis to explain the

pain." This is certainly a possibility, but I would have expected that
were

that the case, and if you did have increased pressure or significant

inflammation, you would have been advised to use pressure lowering eye drops

and medications to manage uveitis.





Paul, several decades of experience have convinced me of the
importance of maintaining the

best possible rapport between patient and surgeon. For each wants the best

possible outcome. On the other hand, when outcomes are not as good as expected,

and don't seem to be improving over time, it can be in everyone's interest to

seek second or third opinions (I have occasionally recommended this to my own

patients because there are two things that I know. The patient trusts their doctor in

the first place and will feel that he will continue to have their best interest
foremost.

The second thing is that if another surgeon can find ways to improve that

patient's well-being, the patient will be better off and will know that they

can come back to me for whatever follow-up needs they may have).





In a complicated retinal situation as you face, an academic

teaching institution

offers an excellent opportunity for a second where there is a multiplicity of subspecialty

care available.





Since you mentioned that you might wish to seek other pathways for
evaluation, I took the

liberty of checking on some of the flights between Sydney, Miami, New York,
Philadelphia

and Boston where four of the very best ophthalmic academic teaching

institutions in the United States are located. (Qantas has a flight to JFK for

$1784 and Delta for $1697).....(Certainly, there are good institutions in the

Midwest and the West of the United States, but the ones with whom I am most

familiar are in the cities that I mentioned).





I will be glad to give you those references if you would like for
me to do so.





Paul, I really hope my thoughts are useful to you. And I

will try to answer any additional specific direct questions you may still have.

However, if you are satisfied, please

rate our conversation. As soon as you have checked out I will collect the

Academic institutions for you and attach them to a follow-up email if you want

me to do so.











Again I want to express my very best wishes



Customer: replied 1 year ago.

 

Hi,

 

Thank you for your reply.

 

Reminder

 

1) The surgeon removed the lens without consent;

2) In removing the lens caused bleeding resulting in two further operations and ongoing pain. According to the Doctor, he used a wrong tool and he dropped the lens.

 

To me, the procedure did not get complicated. It was negligence in failing to remove the lens properly. As I said, a good outcome would have been the lens got removed plus use of gas to repair retina. No further operations including cosmetic, and no ongoing pain.

 

Is that reasonable to determine. If yes, do you think the surgeon could have done a better job? Furthermore, the Doctor said he could have left the lens.

 

Unfortunately, I do not have trust in that surgeon. I have seen other Doctors unable to help due to not knowing exactly what happended during procedure. I have used different drops, however ANY drops I use results in more pain.

 

 

So, frankly I would like to know, is the surgeon negligent?

Please help me to determine!!

 

 

 

 

 

 

 

Expert:  Dr. Tom replied 1 year ago.
Paul, Your points are well taken.

Under the circumstances, it seems that there are two directions that could be taken at this point.

One would be to seek the answer to your question from an un-biased retina specialist.( that may mean traveling to a different city from where you are currently being evaluated).

The second is to carry your records in for a legal opinion. It's my understanding that " negligence" has to be proven in some type of forum where both parties are allowed to make their respective case.

I hope that our days of discussion have been helpful to you. Let me know how things go for you. I am certainly interested. Best wishes.
Expert:  Dr. Tom replied 1 year ago.
Dear XXXXX,

I see that you have not rated my help to you. I would be very grateful if you would take a minute to grade me on the time and effort that I have spent trying to help you. My objective is to provide you with a good service. You have a very difficult situation deal with. I've tried to answer every comment and question that you raised. I want you to be satisfied. If there's anything else I can offer, please let me know. If not, please click the big smiling face to indicate your satisfaction with my help.
Customer: replied 1 year ago.


Ok. Thank you.


In summary,


 


Any recommendations re. treating my eye and what causing the pain.


 


Also, once more if I may kinldy ask, do you think the Doctor failed in removing the lens?


 


Kind regards


Paul


 

Expert:  Dr. Tom replied 1 year ago.

Hello again, Paul,

To address your question: "do you think the Doctor failed in removing the lens?".... in most situations where there is old trauma, an iris scared to a partially resorbed cataractous lens and the need for the surgeon to have excellent visuaization to repair a retinal detachment, I would have said that... yes, it would be appropriate to remove the old scarred lens.


But you stated earlier in this thread that the surgeon said: 'The surgeon afterwards agreed he should have left the lens'.

If the surgeon said that he should have left the lens, this statement speaks for itself .

As for additional treatment, . Without a thorough examination , an ophthalmologist cannot make an assessment as to what is causing your continued pain. Since you have lost confidence in your surgeon, it seems reasonable and prudent that you put your care under an other ophthalmologist.

Please let me know how things work out for you. I am very interested to know what your new ophthalmologist finds and how you get along. best wishes.

Customer: replied 1 year ago.


Thank you for your reply.


 


I am under the care of an ophthalmologist and I shall keep you informed.


 


Just so I can understand,


 


The surgeon said that during surgery the lens kept getting stuck on the wound he created. This caused bleeding and fluid to come out, resulting in the procedure to be unsuccessful. Hence, two further surgeries after that.


 


can I assume if the surgery went well, the lens would have been removed and no further surgery. Is it reasonable to expect a satisfactory outcome for me? Or regardless this was bound to happen.


 


 


 

Expert:  Dr. Tom replied 1 year ago.

Paul, I will try to answer your follow up question:

"can I assume if the surgery went well, the lens would have been removed and no further surgery." Yes...that is a reasonable assumption.

" Is it reasonable to expect a satisfactory outcome for me?" Yes. You had to have your RD repaired or you could have been much worst, possibly even losing your eye if it was not repaired.

Please consider rating our encounter together now. You can always come back with more questions later. Best wishes again.

Dr. Tom, Board Certified MD
Category: Eye
Satisfied Customers: 263
Experience: 30 years experience treating patients with eye problems
Dr. Tom and other Eye Specialists are ready to help you
Customer: replied 1 year ago.


Ok. Thank you.


 


Kind regards


Paul


 

Expert:  Dr. Tom replied 1 year ago.
Thanks for the nice rating Paul....best wishes!

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