Bilateral refractive lens exchange (RLE) complicated by subsequent unilateral retinal detachment: No fault found in performance of immediate sequential bilateral surgery.
Bilateral RLE was performed by a private ophthalmologist as ISBCS in a 56y male for high myopia. Posterior capsular rupture occurred in one eye. At the planned postoperative visit 3 weeks after surgery a large retinal detachment was found in that eye, precipitating further surgery at a public health care hospital. The patient filed a complaint with the Swedish Medical Responsibility Board (MRB, Hälso- och sjukvårdens ansvarsnämnd) against the ophthalmologist.
The MRB ruled that it was an error to perform the surgery in both eyes on the same day because the indication was high myopia in otherwise healthy eyes. In their view the high myopia resulted in increased risk for complications during and after the operation when compared with routine cataract surgery. The ophthalmologist appealed to the County Administrative Court (CAC, Länsrätten). The Swedish Board’s of Health and Welfare (SBHW, Socialstyrelsen) expert advisor in ophthalmology professor Anders Heijl concluded that there was no indication that the ophthalmologist had acted against science and approved experience (vetenskap och beprövad erfarenhet) as RLE is an acknowledged treatment modality for high myopia. The risk situation was not changed in any way by the fact that both eyes were operated on the same day.
The CAC ruled in their final decision that the ophthalmologist had not made any error.
A longer description of this case is available in the Journal of Swedish Medical Association (Läkartidningen), at
Those not fluent in Swedish 🙂 please find my translation here Swedish medicolegal case 2007