Dr L offered Mr M corneal graft surgery
in order to improve his symptom of
deteriorating vision. He was counselled
regarding complications, specifically that
eye infections were a possibility, but he was
not told about the rare risk of loss of the
eye. Dr L performed uncomplicated corneal
graft surgery on the right eye, and before
discharging Mr M, provided him with his
mobile phone number and a postoperative
information leaflet, which informed patients
that they should contact him immediately if
they experienced any pain or poor vision.
Written records show that Dr L reviewed
Mr M on the first day post-surgery. He was
satisfied with the eye and prescribed a
topical corticosteroid and a topical antibiotic.
On the morning of the second day following
the surgery, written and telephonic records
show that Dr L gave Mr M a courtesy call
and that Mr M did not inform Dr L of any pain
during this conversation. Twenty-four hours
later, Mr M called Dr L and complained of
severe, worsening pain in the right eye, that
started shortly after Dr L’s phone call the
previous day. Dr L saw Mr M immediately and
observed a fulminant endophthalmitis.
Mr M was referred to Dr G, a vitreo-retinal
surgeon, who arranged immediate treatment
with intra-vitreal and systemic antibiotics. A
posterior vitrectomy and lensectomy were
performed, but B-scan ultrasonography
later showed a retinal detachment. Bacterial
culture of the vitreous revealed a serratia
marcescens infection, sensitive to the
antibiotics being used. As a result of the
retinal detachment Mr M lost all vision in the
right eye. His corrected visual acuity in the
left eye was 6/36.
Mr M made a claim against Dr L, alleging that
he had failed to inform him of the risks of
corneal graft surgery or of the significance
of pain postoperatively. He further alleged
inadequate postoperative care, which led to
Mr M developing an uncontrolled infection
and subsequent blindness in that eye.
Expert opinion
Medical Protection sought expert opinion
from an ophthalmologist. She was
supportive of the care provided by Dr L and
concluded that the postoperative patient
information leaflet had sufficient information
about warning signs. She also noted that
Dr L did warn that eye infections were a
possible complication and opined that loss
of vision due to an infection was such a rare
complication that the patient did not need to
be warned specifically about the risk.
The expert made the additional point that,
in Mr M’s case, there was a real risk that the
natural course of the disease may have led
to blindness through the complications of
keratoconus itself, in the long term.
The case was considered to be defensible
and was taken to trial. The court was
satisfied that Dr L’s management was
appropriate and that there was no evidence
of a failure to provide adequate informed
consent or negligent after care. Judgment
was made in favour of Dr L.