Defense Verdict in Ophthalmology Case

Defense Verdict in Ophthalmology Case

Senior Trial Partner Thomas A. Mobilia assisted by second chair and Partner Aryeh Klonsky, obtained a defense verdict in September in Supreme Court, Suffolk County.

This matter involved a then 49 year-old, married man with Parkinson’s disease, who first presented to our client, a cornea transplant surgeon, in 2013 with a fungal infection/corneal ulcer of the left eye causing loss of vision for 2months and progressive left eye pain.  The following day, December 24,2013, our client performed an emergency penetrating keratoplasty (corneal transplant) at the Hospital under general anesthesia without complication.

Several months postoperatively, plaintiff developed a cataract with irregular astigmatism in his left eye consistent with secondary keratoconus.  During the postoperative period, plaintiff also experienced corneal graft rejection and loosening of the corneal sutures necessitating their removal.  In order to improve visual acuity, our client recommended cataract extraction surgery with implantation of an artificial intraocular lens (IOL) under local peribulbar anesthesia.  Surgery was scheduled for March 20, 2015 (15months post-corneal transplant) at an Ambulatory Eye Surgery Center.

On the day of surgery, co-defendant anesthesiologist performed the peribulbar block in anticipation of cataract extraction surgery.  Upon injection of the peribulbar anesthetic, plaintiff’s eye became soft, the corneal transplant wound dehisced, and the cataract lens expulsed through the opening.

Our client immediately assessed plaintiff and emergently placed several sutures to temporarily close the dehisced wound.  He then recommended a second peribulbar injection of anesthetic to complete a more thorough repair. Our client decided against attempting to implant the artificial IOL during this procedure. Postoperatively, he continued to follow plaintiff for over a year, and his uncorrected visual acuity remained count fingers only, secondary to aphakia and astigmatism.

Plaintiffs claimed at trial that our client failed to obtain the patient’s informed consent by not discussing the risk of wound dehiscence with peribulbar anesthesia. Further, that the patient should have been offered the option of general anesthesia for the cataract surgery in light of his pre-existing corneal transplant. Plaintiffs also claimed that our client failed to have a preoperative discussion with the anesthesiologist to devise a plan that would minimize the risk of wound dehiscence from peribulbar anesthesia.  In addition to lack of informed consent, plaintiffs’ asserted that the anesthesiologist negligently performed the block causing the wound to dehisce.

As a result of the aforementioned departures from the standard of care, it was claimed that plaintiff sustained a ruptured globe of the left eye, aphakia, loss of vision, scarring of the cornea, lack of depth perception, an inability to undergo surgical placement of an artificial IOL or wear a hard contact lens ,as well as pain and suffering, all of which were permanent. Plaintiff-spouse alleged loss of services. 

During the trial, the defense argued that our client appropriately managed the initial corneal transplant and graft rejection, and that the subsequent cataract surgery was performed at an appropriate time; i.e., when the corneal graft had healed, the graft rejection resolved, and the eye was stable. The defense contended that our client obtained appropriate informed consent for the surgery by informing plaintiff of the risks, benefits, and alternatives to intraocular surgery, including the known and foreseeable risks associated with peribulbar anesthesia. Through expert testimony, the defense also demonstrated that general anesthesia carried significant risks to patients, including additional risks specific to this post-corneal transplant patient with Parkinson’s disease.

The Defense argued that general anesthesia, while necessary for the corneal transplant procedure, was not a safe alternative to peribulbar anesthesia for this cataract surgery. Moreover, prior to plaintiff’s cataract surgery, there were no reported cases of wound dehiscence secondary to peribulbar block in the medical literature. Accordingly, our client utilized appropriate medical judgment when recommending peribulbar block and in obtaining plaintiff’s informed consent. The defense also contended that sufficient information regarding the surgical and anesthesia plan was conveyed to the anesthesiologist preoperatively.

With respect to damages, the defense argued that plaintiff is a candidate for remedial measures to improve the poor vision in his left eye, including additional surgery to implant an artificial IOL or the use a specialized contact lens combined with prism eyeglasses.

After a four week trial, the jury returned a unanimous defense verdict to our client.