Risk management lessons from a review of 168 cataract surgery claims.

One hundred sixty-eight closed claims involving cataract procedures reported to Ophthalmic Mutual Insurance Company (OMIC) over a 10-year period were evaluated. Indemnity payments totaling more than $3 million were made in 37 cases. These 37 cases represented only 7% of all OMIC claims, but their total indemnity payment represented 24% of the total indemnity paid by OMIC during the 10-year period.

Liability issues associated with PRK and the excimer laser.

Given the elective nature of photorefractive keratectomy (PRK), the high expectations of patients, and misconceptions of the general public about refractive surgery, the use of the excimer laser for PRK opens the door to new liability risks for ophthalmologists and, in the comanagement environment, referring optometrists. The authors discuss informed consent, marketing, comanagement, and off-label use guidelines and protocols to help protect ophthalmologists against claims and better defend those that might arise.

Medication errors result in costly claims for ophthalmologists.

Medication errors are a frequent cause of medical malpractice claims. Because serious injury often results, medication errors can be costly to defend, indemnify or settle. A review of five closed claims involving glucocorticoids, corticosteroids, antibiotics and silver nitrate offers insight into how ophthalmologists can protect themselves against medication malocurrences.

Pyogenic granulomas of the cornea.

Pyogenic granulomas are vasoproliferative, inflammatory lesions composed of granulation tissue, which occur on cutaneous or mucosal tissues, often arising secondary to other processes such as trauma or infection. Conjunctival pyogenic granulomas are not rare, but corneal involvement is very unusual and can occasionally lead to problems in the differential diagnosis of corneal masses. We report three cases of pyogenic granuloma involving the cornea. The clinicopathologic features of these cases and a review of the literature on the ocular manifestations of this condition are presented.

Orbital haemorrhage and prolonged blindness: a treatable posterior optic neuropathy.

Two patients developed traumatic orbital haemorrhage resulting in prolonged blindness. Orbital decompression successfully reversed the visual loss, though both eyes had no light perception for at least 3 1/2 hours. The clinical findings suggest damage to the posterior optic nerve as cause of the visual loss. The optic nerve tolerance time to ischaemic injury may be longer than previously thought.

Ocular lesions associated with dissemination of type 2 herpes simplex virus from skin infection in newborn rabbits.

The subcutaneous inoculation of the backs of New Zealand white rabbits 17 to 34 hr old with 10(3) 50% tissue culture infection dose (TCID50) of type 2 herpes simplex virus (HSV-2) induced cutaneous lesions within 24 hr, foci of disseminated infection in many organs (including the eye) on day 3 and thereafter, and the death of the animals on day 5 with infection of the central nervous system. Infectious HSV-2 could be isolated from the mononuclear cells and plasma of the peripheral blood, indicating the active role of both elements in the dissemination of the virus. Infectious HSV was also recovered from the corresponding sensory ganglia of the skin lesion (the cervicothoracic ganglia) as early as 2 days after the subcutaneous inoculation of the virus. About 40% of the animals developed ocular consisting of retinal folds with or without degenerative changes, Iritis and choroiditis also developed in some eyes. Infectious HSV-2 could be isolated from 33% of the eyes on days 4 and 5. Thus the newborn rabbit may serve as a suitable experimental animal for the study of HSV-2-induced chorioretinitis in the human newborn.