State Consumer Disputes Redressal Commission
Ishtiaq Ahamd Siddiqui vs Dr. V.K. Garg on 14 March, 2023
Cause Title/Judgement-Entry STATE CONSUMER DISPUTES REDRESSAL COMMISSION, UP C-1 Vikrant Khand 1 (Near Shaheed Path), Gomti Nagar Lucknow-226010 Complaint Case No. CC/92/2018 ( Date of Filing : 19 Mar 2018 ) 1. Ishtiaq Ahamd Siddiqui Lucknow ...........Complainant(s) Versus 1. Dr. V.K. Garg Lucknow ............Opp.Party(s) BEFORE: HON'BLE MR. Rajendra Singh PRESIDING MEMBER HON'BLE MR. SUSHIL KUMAR JUDICIAL MEMBER PRESENT: Dated : 14 Mar 2023 Final Order / Judgement Reserved State Consumer Disputes Redressal Commission U.P. Lucknow. Complaint Case No.92 of 2018 Ishtiaq Ahmad Siddiqui s/o Muneer Ahmad Siddiqui, R/o 2/193, Viram Khand, Gomti Nagar, Lucknow. ...Complainant. Versus Dr. V.K. Garg, B-54, Nirala Nagar, Lucknow. ...Opposite party. Present:- 1- Hon'ble Sri Rajendra Singh, Member. 2- Hon'ble Sri Sushil Kumar, Member. Sri Ziya Ahmad, Advocate for the complainant. Sri Ankit Srivastava, Advocate for OP. Date : 5.4.2023 JUDGMENT
Per Sri Rajendra Singh, Member- This complainthas been filed by the complainant Ishtiaq Ahmad under section 17 of the Consumer Protection Act, 1986 for following reliefs:-
Direct the respondent to give medical expenditure of Rs.3,00,000.00 to the complainant.
Direct the respondent to give journey charges as well as staying charges of Rs.3,00,000.00 to the complainant.
Direct the respondent to give Rs.20,00,000.00 to the complainant on account of mental agony.
Allow the complaint and direct the respondent to pay a sum of Rs.50,000.00 towards the cost of case.
Any other order which this Hon'ble Commission may deem fit and proper in the circumstances of the case may also be passed.
The brief facts of the complaint case are that, that on 13.5.2017, the complainant aged about 75 years approached to the respondent for eye treatment. On the same day he was told by the respondent that he is suffering from Retina Detachment in the left eye and recommended for eye surgery and he claimed to have all the necessary expertise and facilities. On the basis of recommendation of the complainant done the pathological test which suffered him financially and mentally. Upon the recommendation the complainant deposited the total fee of Rs.51,500.00 along with medicine charges and conveyance charges of Rs.2,000.00 as such in total of Rs.60,000.00. Thereafter the surgery was done on 17.5.2017. Thereafter, the complainant came for regular visit, which suffered him financially and mentally.
After the aforesaid surgery has been successfully done as claimed by the respondent. The surgery was done basically against the retina detachment. It was comprehensively promised by the respondent that the retina detachment has been cured but it was complete failure. After some time, the said problem was repeated again and complainant visited again at respondent's clinic for the same problem i.e. retina detachment. The respondent accepted his failure and emphasized for the urgent second surgery as soon as possible. Hence, the complainant undergone for pathological test which again suffered him financially and mentally.
The second surgery was performed by the respondent on 28.6.2017. On the second occasion the complainant deposited fee of Rs.50,000.00 along with medicine and conveyance charges of Rs.2,000.00. As such in total of Rs.60,000.00.It is made clear that the respondent has charges the fees twice for the said treatment from the complainant which clearly shows that the respondent has deliberately and with ulterior motive did not perform the first operation in an effective manner. Even after the second surgery there was an assurance from the respondent that the problem is cured but the complainant again felt the persistent problem even after the second surgery which feebled him physically and mentally.
The complainant got the assurance from the respondent on every subsequent visit and that the complainant was not satisfied with the assurance given by the respondent then he moved to Delhi at Shroff Eye Centre for second opinion on 28.7.2017. The complainant was undergone for another surgery on 17.8.2017 at Shroff Eye Care, New Delhi as the operation had to done immediately which cost around Rs.1,00,000.00. Thereafter, the complainant was undergone for Silicon Oil Removal (SOR) on 5.1.2018 which again suffered him financially and mentally. The complainant had to visit several times at Shroff Eye Care, New Delhi with one of the attendant due to which he spent huge amount of money and suffered physically in the old age.
The complainant wrote a letter to the respondent for damages done and mental harassment he faced but there was no positive sign from the side of respondent. A written complaint was sent to Medical Council of India as well as UP Medical Council but no further response the complainant got from UP Medical Council despite the positive response and strict instruction from Medical Council of India. The respondent adopted unfair means to earn the money which is also against the ethics of medical profession for which they are liable to be punished. Due to negligent act done by respondent the complainant is still visiting New Delhi at Shroff Eye Care which cost him financially as well as mentally at the age of 75 years. The Sankara Netralaya Chennai & Shroff Eye Care, New Delhi both have issued the letter regarding the negligence done by the respondent.
The opposite party has filed his written statement and stated that the alleged treatment of the complainant took place in the Nursing Home known as 'Garg Opthalmic Centre' the same is both the necessary as well as the proper party to the dispute, however, the complainant has not impleaded the same accordingly the present complaint is bad in the eyes of law for the non-joinder of the necessary parties. The aforesaid Nursing Home is also insured with the United India Insurance Co. Ltd. However, as a matter of fact and record the complainant has not impleaded the said insurance company as an opposite party. The United India Insurance Co. Ltd is both the necessary as well as the proper party to the dispute, however, the complainant has not impleaded the same accordingly the present complaint is bad in the eyes of law for the non-joinder of the necessary parties.
The complainant came for his treatment of retina and was diagnosed to be suffering from Partial RhegmatogenousRetinal Detachment. The retina is the innermost, light-sensitive "coat", or layer, of shell tissue of the eye of most vertebrates and some mollusks. The optics of the eye create a focused two-dimensional image of the visual work on the retina, which translates that image into electrical neural impulses to the brain to create visual perception, the retina serving much the same function as film or a CCD in a camera. The retina consists of several layers of neurons interconnected by synapses. Retinal detachment is a disorder of the eye in which the retina separates from the layer underneath. Symptoms include an increase in the number of floaters, flashes of light and worsening of the outer part of the visual field. This may be described as a curtain over part of the field of vision. In about 7% of cases both eyes are affected. Without treatment permanent loss of vision may occur. The mechanism most commonly involves a break in the retinathen allows the fluid in the eye to get being the retina. A break in the retina can occur from a posterior vitreous detachment, injury to the eye, or inflammation of the eye. Other risk facts include being short sighted and previous cataract surgery.
Retina detachments affect between 0-6 and 1.8 people per 10,000 per year. About 0.3% of people are affected at some point in their life. It is most common in people who are in their 60s or 70s. Retina detachment can be examined by fundus photography or ophthalmoscopy. Fundus photography generally needs a considerably larger instrument than the ophthalmoscope, but has the advantage of availing the image to be examined by a specialist at another location and/or time, as well as providing photo documentation for future reference. Modern fundus photographs generally recreate considerably larger areas of the fundus than what can be seen at any one time with handheld ophthalmoscopes. The procedure of the treatment involved in the management of the retinal detachment is known as vitrectomy which is in vogue in county. The national trend in practice that Pars Plana Vitrectomy has become dominant operative procedure for retinal surgeries including retinal detachment.
Vitrectomy is an increasingly used treatment for retinal detachment. It involves the removal of the vitreous gel and is usually combined with filling the eye with either a gas bubble (SF6 or C3F8 gas) or silicone oil (PDMS). An advantage of using gas in this operation is that there is no myopic shift after the operation and gas is absorbed within a few weeks. PDMS, if used, needs to be removed after a period of 2-8 months depending on surgeon's preference. Silicone oil is more commonly used in cases associated with proliferative vitreo-retinopathy (PVR).
It is submitted that the post vitrectomy surgery of retinal detachment is not bereft of surgical complications. Post operation, despite what seems like initial successful surgery the retina can easily become detached again. This necessitates repeat surgery to correct the retinal detachment. Retinal re-detachment can occur due to variety of reasons including:
Re-opening of old retinal breaks.
Formation of new retinal breaks.
Proliferative vitreoretinopathy (PVR).
It is submitted that PVR causes scarring of retina. Normally a thin and a pliable lining, the retina become thickened and wrinkled and difficult to remain attached to the wall of the eye. PVR occurs in up to 10 percent of retinal detachments, and is a major and most common cause of retinal re-detachments. Further development of PVR results in markedly reduced visual outcomes compared to retinal detachment not complicated by PVR with only 11 to 25 percent of the patients achieving a visual acuity of 20/100. In the context of repeat vitreoretinal surgery, the rare occurrence of the sympathetic ophthalmia, is estimated to be approximately 1 in 800. Managing patients with retinal detachments complicated by PVR remains a challenging yet often rewarding part of vitreoretinal surgery with the ability to reattach the retina in the majority of cases. Although some patients require multiple procedure.The vitreretinal surgeons across the globe feel justified in continuing to operate on these complex cases and the studies suggest that such attempts are worthwhile. Accordingly, it is not out of place to mention herein that doctors can not be guarantors of absolute safety and reactionary complications can not be alleged to constitute medical negligence.
The reactionary complications of the said surgeries in case of retinal detachment where silicon oil or C3F8 (gas) is used the re-detachment is a common reactionary complication which can not be ruled out. The repair of recurrent inferior retinal detachment under silicon oil may be achieved with prone positioning and later when and if the retina flattens with supplemental laser photocoagulation this face down position may allow the silicon oil to tamponade the interior retina and the responsible retinal hole to achieve retinal re-attachment. If this fails or if a significant tractional component remain repeat surgery becomes necessity.
Admittedly the facts stated hereinabove clearly indicates that re-detachment and re-surgery are common in case of vitrectomy surgery. Further it is submitted that doctors can not be guarantors of absolute safety and reactionary complications can not be alleged to constitute medical negligence. It is also submitted that no negligence can be alleged where the complainant is not able to show that method of treatment was not in accordance with standard procedure. Admittedly no such allegations have been leveled by the complainant so as to say that the answering opposite party deviated from any standard procedure required in vetrectomy surgery.
The complainant on 13.5.2017 visited the clinic Garg Ophthalmic Centre with a complaint in his vision. After the procedural check ups the complainant was diagnosed with partial Rhegmatogenous Retinal Detachment and was advised to undergo Pars Plana Vitrectomy Surgery with endo laser and gas. He was also asked to undergo certain pre-operative tests which were necessary for conducting the surgery. After the necessary preoperative tests were got conducted by the complainant and all the necessary investigations were found to be normal, the Pars Plana Vitrectomy Surgery with endo laser was conducted to attach the retina thereafter the gas C3F8 was injected on 17.5.2017.
It is pertinent to point out that a post operative care the complainant was asked to lie down on the left side in the lateral position, it is not out of place to mention here that in case the said manner is not followed as prescribed the re-detachment may occur.
On 18.5.2017. the regular dressing was done and upon checking the retina the same was found to be in order. The routine check up thereafter was conducted on 27.5.2017 and 10.6.2017 whereby the complainant had no issues nor there was any defect in the said retinal attachment. On 26.6.2017, the complainant came with the complaint of sudden loss of vision on one day duration. Upon check up he was diagnosed with recurrent retinal detachment with PVR and was asked to undergo the surgery once again. This time with silicon oil. The said surgery was conducted on 28.6.2017.
As stated hereinabove, the recurrent retinal detachment with PVR is the most common reactionary complications which can occur. On 29.6.2017 i.e. the first day after the second surgery the retina was found to be in order. Moreover, the complainant also did not raise any issue or complaint with regard to the second surgery. For post operative check up the complainant visited the aforesaid clinic on 7.7.2017 whereby the retina was found to be in order moreover, the complainant also did not raise any issue or complaint. The complainant again visited the aforesaid clinic on 21.7.2017 whereby complainant was seen in the clinic though the oil which was filled caused a hazy view (as stated hereinabove it takes about 8 weeks for retina to settle land extract the oil). However, as a matter of fact and record, the retinal looked all O.K. and the complainant also did not raise any issue or complaint.
Subsequently the complainant again visited the clinic for post operative check up on 1.8.2017 whereby his retina was re-examined in accordance with the procedure prevalent in the city Lucknow i.e. by using indirect ophthalmoscope. The retina was found to be in position however the view hazy due to silicon oil which could not be extracted before eight weeks. The complainant also did not raise any issue or complaint in his eyes. Undoubtedly the machineries/ equipment available in New Delhi is much more advance than available in Lucknow. Admittedly, expected complications can not be equated with negligence no negligence can be alleged where the complainant is not able to show that method of treatment was not in accordance with standard procedure in present case there is no allegations to the effect that there has been any failure on part of the answering opposite party in following the standard procedure or there has been any absence of due diligence on his part. Doctors can not be guarantors of absolute safety and reactionary complications can not be alleged to constitute medical negligence.
The opposite party is one of the leading ophthalmologist in city of Lucknow having special qualifications and training in retinal surgery having been trained in retinal surgery at ShankaraNeralaya, Chennai and has also obtained a Gold Medal for Vitreo Retinal Surgery. It is submitted that the cost of oil & equipment only was charged. The fee for second operation was not taken from the complainant. The complainant did not make complaint with respect to his vision for a post operative period of more than one month.
It is submitted that the removal of the silicon oil is a routine procedure, which is done after a minimum of 8 weeks of surgery whereby silicone oil so filled in the vitreous during the surgery is removed. The complainant had to visit the answering opposite party for the removal of the silicone oil. However, he was lost to follow up.
The OCT test of the eye was conducted at Shroff Eye Centre. It is pertinent to point out that while checking the eye and retina in case of post operative situations the procedure which is adopted in a routine course is known as indirect ophthalmoscopy. When the oil is filled the view of retina complaints about blurred vision or any other problem the OCT method is adopted. The complainant visited the clinic on 1.8.2017 and his retina and eye was tested by adopting indirect ophthalmoscopy method. At that particular stage oil was filled and prima facie it appeared that there are no issues with regard to the surgery. The complaint also did not raise any complaint with regard to his vision.
The complainant is not entitled for any relief whatsoever rather the present complaint being an abuse of process of law deserves to be dismissed out rightly and that too with exemplary cost.
We have heard ld. Counsel for the complainant Sri Pratush Tripathi and ld. Counsel for the opposite parties Sri Kamal Kumar Singh Visht and perused the entire record.
First we have to seeand discuss about retinadetachment, its examination / diagnosis, its procedure for attachment and consequences of attachment.
Diagnosis Your doctor may use the following tests, instruments and procedures to diagnose retinal detachment:
Retinal examination. The doctor may use an instrument with a bright light and special lenses to examine the back of your eye, including the retina. This type of device provides a highly detailed view of your whole eye, allowing the doctor to see any retinal holes, tears or detachments. Ultrasound imaging. Your doctor may use this test if bleeding has occurred in the eye, making it difficult to see your retina.
Your doctor will likely examine both eyes even if you have symptoms in just one. If a tear is not identified at this visit, your doctor may ask you to return within a few weeks to confirm that your eye has not developed a delayed tear as a result of the same vitreous separation. Also, if you experience (12) new symptoms, it's important to return to your doctor right away.
More Information Ultrasound Treatment Surgery is almost always used to repair a retinal tear, hole or detachment. Various techniques are available. Ask your ophthalmologist about the risks and benefits of your treatment options. Together you can determine what procedure or combination of procedures is best for you.
Retinal tears When a retinal tear or hole hasn't yet progressed to detachment, your eye surgeon may suggest one of the following procedures to prevent retinal detachment and preserve vision.
Laser surgery (photocoagulation). The surgeon directs a laser beam into the eye through the pupil. The laser makes burns around the retinal tear, creating scarring that usually "welds" the retina to underlying tissue. Freezing (cryopexy). After giving you a local anesthetic to numb your eye, the surgeon applies a freezing probe to the outer surface of the eye directly over the tear. The freezing causes a scar that helps secure the retina to the eye wall.
Both of these procedures are done on an outpatient basis. After your procedure, you'll likely be advised to avoid activities that might jar the eyes -- such as running -- for a couple of weeks or so.
Retinal detachment Pneumatic retinopexyEnlarge image If your retina has detached, you'll need surgery to repair it, preferably within days of a diagnosis. The type of surgery your surgeon recommends will depend on several factors, including how severe the detachment is.
Injecting air or gas into your eye. In this procedure, called pneumatic retinopexy (RET-ih-no-pek-see), the surgeon injects a bubble of air or gas into the center part of the eye (the vitreous cavity). If positioned properly, the bubble pushes the area of the retina containing the hole or holes against the wall of the eye, stopping the flow of fluid into the space behind the retina. Your doctor also uses cryopexy during the procedure to repair the retinal break.Fluid that had collected under the retina is absorbed by itself, and the retina can then adhere to the wall of your eye. You may need to hold your head in a certain position for up to several days to keep the bubble in the proper position. The bubble eventually will reabsorb on its own. Indenting the surface of your eye. This procedure, called scleral (SKLAIR-ul) buckling, involves the surgeon sewing (suturing) a piece of silicone material to the white of your eye (sclera) over the affected area. This procedure indents the wall of the eye and relieves some of the force caused by the vitreous tugging on the retina.
If you have several tears or holes or an extensive detachment, your surgeon may create a scleral buckle that encircles your entire eye like a belt. The buckle is placed in a way that doesn't block your vision, and it usually remains in place permanently.
Draining and replacing the fluid in the eye. In this procedure, called vitrectomy (vih-TREK-tuh-me), the surgeon removes the vitreous along with any tissue that is tugging on the retina. Air, gas or silicone oil is then injected into the vitreous space to help flatten the retina.
Eventually the air, gas or liquid will be absorbed, and the vitreous space will refill with body fluid. If silicone oil was used, it may be surgically removed months later.Vitrectomy may be combined with a scleral buckling procedure.
After surgery your vision may take several months to improve. You may need a second surgery for successful treatment. Some people never recover all of their lost vision.
Coping and support Retinal detachment may cause you to lose vision. Depending on your degree of vision loss, your lifestyle might change significantly.
You may find the following ideas useful as you learn to live with impaired vision:
Get glasses. Optimize the vision you have with glasses that are specifically tailored for your eyes. Request safety lenses to protect your better-seeing eye. Brighten your home. Have proper light in your home for reading and other activities.
Make your home safer. Eliminate throw rugs and place colored tape on the edges of steps. Consider installing motion-activated lights. Enlist the help of others. Tell friends and family members about your vision problems so they can help you. Get help from technology. Digital talking books and computer screen readers can help with reading, and other new technology continues to advance. Check into transportation. Investigate vans and shuttles, volunteer driving networks, or ride shares available in your area for people with impaired vision. Talk to others with impaired vision. Take advantage of online networks, support groups and resources for people with impaired vision.
Preparing for your appointment Here's some information to help you get ready for your appointment.
What you can do Be aware of any pre-appointment restrictions. At the time you make the appointment, ask if you need to do anything in advance. List any symptoms you'reexperiencing, including those that seem unrelated to the reason for which you scheduled the appointment. List key personal information, including major stresses and recent life changes.
List all medications, vitamins and supplements that you're taking, including doses.
Ask a family member or friend to come with you. You may wish to ask someone who could drive you home if your eyes are dilated as a part of your exam. Or this person could write down information from your doctor or other clinic staff during the appointment. List questions to ask your doctor.
For retinal detachment, some basic questions include:
What's the most likely cause of my symptoms?
What are other possible causes of my symptoms?
What tests do I need? Do they require any special preparation?
Is my condition likely temporary or ongoing?
What are my treatment options, and which do you recommend?
What are the alternatives to the first approach that you're suggesting?
I have another medical condition. How can I best manage them together?
Do I need to restrict my activities in any way?
Do I need to see another specialist?
Do you have any brochures or other printed material I can take with me? What websites do you recommend? What will determine whether I should plan for a follow-up visit?
If I need surgery, how long will recovery take?
Will I be able to travel after surgery? Will it be safe to travel by plane?
What to expect from your doctor Your doctor is likely to ask you a number of questions, such as:
When did you first start having symptoms?
Do you have your symptoms all the time, or do they come and go?
How severe are your symptoms?
Have you had any symptoms in your other eye?
Have you ever had an eye injury?
Have you ever experienced eye inflammation?
Have you ever had eye surgery?
Do you have any other medical conditions, such as diabetes?
Have any of your family members ever had a retinal detachment?
What to know about a vitrectomy procedure What is vitrectomy surgery?
Why would you need a vitrectomy?
Complications and risks What is the recovery process?
Vitrectomy surgeries involve the removal and replacement of some or all of the vitreous humor or fluid from the eye. The procedure is considered very successful and is often done as part of other eye surgeries.
Depending on the additional procedures involved, most people start to recover from vitrectomy surgeries after a few days, but a full recovery often takes several weeks.
Fast facts on vitrectomy surgery:
Vitreous humor is a gel-like substance made of at least 98 percent water.
Vitrectomy is an outpatient surgery, performed in hospital or dedicated ambulatory surgery center. The vitreous cavity gives the eye its round shape and makes up at least two-thirds of the volume of the eye After vitrectomy surgeries, most people can go home following a short monitoring period.
What is vitrectomy surgery?
Share on PinterestA vitrectomy surgery is when the vitreous humor or fluid surrounding the eye is surgically removed and replaced.
It is important for people to arrange to take a few days off work and to arrange for a ride home after the surgery.
Before the day of their surgery, an appointment will be scheduled to examine the eye that will be operated on.
Usually, people will have to avoid all food and water for at least 8 hours before the surgery is done.
An individual should discuss any current medications they are taking and medical conditions they have with the surgeon, ahead of time. Some medicines may need to be avoided on the day of surgery.
Common steps in vitrectomy surgery include:
1. The eye is anesthetized or numbed and dilated.
2. The eye is cleaned with an antiseptic solution and draped with a sterile covering.
3. An eyelid speculum is used to keep the eye open, and a protective covering is placed over the eye not being operated on.
4. The surgeon makes a small incision or cut, usually about the width of an eyelash or 0.5 millimeters, in the outer membrane of the eye.
5. The surgeon accesses the eye through the pars plana, a structure in the sclera or white part of the eye.
6. The surgeon uses forceps to open the cut.
7. The surgeon inserts a microscope, as well as a fiber-optic light to be able to see the eye.
8. The surgeon uses a vitrector or vitrectomy probe to cut the vitreous gel, and a suction tool to remove broken down fluid.
9. Depending on the individual case the surgeon will then:
use forceps, scissors, and cutters to peel back scar tissue from the retina insert a silicone-tipped needle to drain infected, cloudy, or bloody fluid use a laser probe, to treat abnormal blood vessels, clots, and seal off retinal injuries, such as tears or holes
10. The surgeon fills the eye with a vitreous substitute similar to saline solution, silicon oil, or a gas or air bubble.
11. An antibiotic ointment will be applied to the eye to prevent infection and the eye will be covered.
12. The individual may need to lay face down for a while to be monitored, and instructions will be given, depending on what other procedures are done on the eye.
Vitrectomy procedures are often done to allow surgeons access to the back of the eye, during operations for retinal conditions.
It is also commonly done to drain vitreous fluid that has become cloudy or bloody, or filled with floaters or clumps of tissue.
Common reasons for a vitrectomy surgery, and other surgeries associated with it include:
bleeding inside of the eye eye infections major eye trauma or injury problems after cataract (cloudy lens) surgery vitreous floaters or tiny bits of tissue in the vitreous fluid damaged retinal tissue or scar tissue on the retina injury from a dislodged, misplaced, or infected intraocular lens (IOL) detached retina where the retina becomes loose and moves around the eye trauma or injury that occurs during cornea, cataract, or glaucoma surgery diabetic retinopathy when the retina has been damaged by long periods of uncontrolled diabetes macular degeneration or a macular hole where there is a small hole, tear, or defect in the macula or central tissue of the retina swelling of the central retinal tissue swelling of the eye Complications and risks Share on PinterestComplications are rare for virectomy procedures, and the surgeons should explain the potential risks to the patient before performing the surgery.
Vitrectomy procedures are an effective surgery and severe complications are rare. According to the American Society of Retina Specialists, most surgeries have a 90 percent success rate.
In rare cases, however, complications can occur, especially in immune-compromised individuals and those with a history of eye conditions or surgery.
Possible side effects of vitrectomy procedures include:
inflammation or redness, swelling, and pain bleeding inside the eye infection increased pressure (glaucoma) or reduced pressure in the eye cataract formation or progression of existing cataracts surgical injury, such as a wrong cut or tear, resulting in the need for further corrective surgery swelling of the central part of the retina change in vision, requiring the need for new eyeglasses loss of night vision, blurriness, or depth perception double vision retinal detachment dislocation or discoloration of the intraocular lens macular pucker or a wrinkle in the retina loss of vision allergic reaction or over-reaction to anesthesia, which may risk stroke, heart attack, or pneumonia What is the recovery process?
Vitrectomy procedures are often done alongside other eye surgeries, so individual recovery time and recommendations vary.
In general, activities like driving, reading, and exercise will need to be avoided for a few days after the procedure.
Some people will be required to lay face down for a period of time to help their eye heal properly. Often, eye drops will be prescribed to help prevent infection and to reduce inflammation.
In general, the full recovery process for vitrectomy surgeries takes between 4 to 6 weeks.
Objective To identify potential risk factors for recurrent retinal detachment after surgical treatment for rhegmatogenous retinal detachment with choroidal detachment (RRD-CD) in a Chinese population.
Methods A total of 1212 patients with RRD-CD admitted to Beijing Tongren Hospital from 2004 to 2018 were reviewed retrospectively. The rate of recurrent retinal detachment was calculated, and risk factors were analyzed by logistic regression analysis.
Results The average age of the patients was 48.51 years, 760 patients (62.7%) were male, and 630 patients (52.0%) had right eye disease. The recurrence rate in the same eye was 21.3%. The incidence of recurrence retinal detachment was higher in patients who were male, middle age, and with poor preoperative vision, longer axial length, and scleral buckling. Recurrence usually occurred 3 months after surgery.
Conclusion Male, middle age, longer axial length, and scleral buckling could be risk factors for recurrent retinal detachment following surgical treatment in patients with RRD-CD.
Keywords: rhegmatogenous retinal detachment, choroidal detachment, risk factor Introduction Rhegmatogenous retinal detachment associated with choroidal detachment (RRD-CD) is due to ciliary and choroidal body detachment and characterized by quick progression and poor prognosis.1 RRD-CD accounts for 7.6-18.7% of RRD patients in China, significantly higher than the rate in Western countries (2.0-4.5%).2-4 RRD-CD is commonly associated with the breakdown of the blood ocular barrier, the migration of retinal epithelium, the release of inflammatory factors, and the development of proliferative vitreoretinopathy (PVR).5-7 Surgical treatment remains the mainstay for RRD-CD management, but surgical procedures are complex, and CD is considered an unfavorable factor for RRD surgery due to high incidence of postoperative PVR.8 Despite improved surgery strategies for detachment repair for RRD-CD, the recurrence rate of retinal detachment is still high. Therefore, it is important to identify risk factors for the failure of retinal detachment repair to improve the prognosis of RRD-CD.
This study aimed to identify potential risk factors for recurrent retinal detachment after surgical treatment for RRD-CD in a Chinese population. We retrospectively analyzed the clinical characteristics of RRD-CD in our hospital in the past 15 years, especially clinical characteristics of RRD-CD patients with recurrent retinal detachment after the first operation.
Methods Data Collection This study was approved by the Ethics Committee of Beijing Tongren Hospital, Capital Medical University in compliance with the principles of the Declaration of Helsinki. All patients provided informed consent. All electronic case records from January 2004 to December 2018 in the Department of Ophthalmology of Beijing Tongren Hospital were integrated to establish a database. The database was searched for all medical records with the first diagnosis of RRD-CD. If the patient had multiple medical records of recurrent RRD or contralateral eye surgery, it was considered a case record. Inclusion criteria: RRD-CD was diagnosed and the first surgery was performed in our hospital. The exclusion criteria were as follows: retinal reattachment was performed more than once in other hospitals; no retinal hole was found in exudative retinal detachment, tractive retinal detachment, or combined retinal detachment. The information on patient demographics, including age, gender, RRD-CD duration, and co-existing diseases such as diabetes and hypertension, and the details on ophthalmic examinations, including intraocular pressure (IOP), best-corrected visual acuity (BCVA), anterior segment evaluation, funduscope examination, ocular ultrasonography, and ultrasonic biomicroscopy, were collected from medical records. Data analysis was based on different age groups: younger than 18 years old, 18-39 years old, and every 20 years for the rest of the age groups.
The types of surgical procedures included pars plana vitrectomy (PPV), scleral buckling (SB), PPV with an encircling band, and types of vitreous substitutes.
Statistical Analysis Statistical analysis was performed using SPSS 17.0 software (SPSS, Chicago, IL, USA). Continuous data were shown as mean and standard deviation (SD), and categorical data were shown as counts and proportions. The comparison was performed by chi-square test. A multivariate analysis with a step-by-step logistic regression was performed to identify risk factors for recurrent retinal detachment after surgery. A 2-tailed P0.05 indicated significance.
Results According to inclusion and exclusion criteria, 1212 patients with RRD-CD were collected. All patients had severe choroidal detachment and their average age was 48.51 years, ranging from 2 to 87 years. The 40-59 age group accounted for 42.8% (516 cases; Figure 1). A total of 760 patients were male (62.7%) and 630 patients had right eye disease (52.0%).
Figure 1 Age distribution of RRD-CD patients. RRD-CD, rhegmatogenous retinal detachment with choroidal detachment.
Table 1 shows patient demographics and clinical parameters. Disease onset varied from 3 days to 2 years, and BCVA varied from no light perception (NLP) to 0.7, and 35.4% was hand movement (HM). IOP values of 0-6 mmHg were found in 513 eyes (42.33%), 7-10 mmHg in 504 eyes (41.58%), 11-15 mmHg in 144 eyes (11.88%), 16-21 mmHg in 40 eyes (3.30%), and over 21 mmHg in 11 eyes (0.91%). Myopia accounted for 92.6% with axial length (AL)26 mm (Figure 2). Pseudophakic/aphakic accounted for about 28.4% (pseudophakic was 21.0%, aphakic eye was 7.3%), with macular detachment in 94.7%. Preoperative regular fundus examination and postoperative diagnosis showed that 503 eyes (41.5%) had multiple holes (2), 104 eyes (8.58%) had great retinal tears (GRT), and 205 eyes (16.91%) had macular holes.
Table 1 Characteristics for RRD-CD in the Two Groups Characteristics Reattachment Group (n=954) Recurrence Retinal Detachment Group (n=258) P value Age (years) 49.22±12.21 45.05±13.42 0.001* Sex Male 581 179 0.012* Female 373 79 BCVA 0.024* ≥0.5 29 1 0.3~0.5 54 2 0.05~0.3 83 6 0.05 232 63 Counting fingers 86 51 Hand movement 351 78 Light perception 116 55 No light perception 3 2 IOP (mmHg) 0.476 ≤6 392 121 7~10 409 95 11~15 113 31 16~21 31 9 21 9 2 Macular status 0.001* Macular hole 186 19 Detachment without macular hole 899 249 Detachment with macular hole 186 19 No detachment 55 9 Axial length (mm) 0.002* 24 89 17 24~26 219 51 26~30 389 89 ≥30 257 101 Lens status 0.546 Phakic 682 187 Pseudophakic 207 47 Aphakic 69 20 Operation mode 0.075 PPV+silicone oil 799 205 PPV+gas 23 9 Scleral buckling 103 41 PPV+encircling band 29 3 Underlying diseases Hypertension 162 33 0.104 Diabetes mellitus 86 19 0.403 Open in a separate window Note: *Indicated significant difference.
Abbreviations: RRD-CD, rhegmatogenous retinal detachment with choroidal detachment; BCVA, best-corrected visual acuity; IOP, intraocular pressure; PPV, pars plana vitrectomy.
Figure 2 Axial length distribution of RRD-CD patients. RRD-CD, rhegmatogenous retinal detachment with choroidal detachment.
Among RRD-CD patients, 85.5% underwent PPV, filling with either silicone oil (82.8%) or gas (2.6%); 11.9% underwent SB, and 2.6% underwent PPV (silicone oil) combined with encircling band.
Among RRD-CD patients, 258 patients had no total retinal reattachment or retinal redetachment after the first operation, accounting for 21.3% of RRD-CD patients. All RRD-CD patients received oral administration of prednisolone acetate 3 to 7 days before the operation. The average age of those patients was 45.05 years, and the male proportion was 69.3%. We found significant differences in age, gender, BCVA, AL, and macular status between the two groups (Tables 1 and and22).
Table 2 Univariate Analysis of Risk Factors for Recurrence Retinal Detachment After the First Operation Odds Ratio 95% Confidence Interval Lower Limit 95% Confidence Interval Upper Limit P value Sex (male) 0.687 0.512 0.923 0.013* Age (years) 0.972 0.967 0.989 0.001* BCVA ≥0.5 8.057 1.092 59.432 0.015* 0.3~0.5 7.698 1.86 31.714 0.001* 0.05~0.3 3.971 1.713 9.201 0.001* 0.05 0.995 0.722 1.370 0.974 Counting fingers 0.402 0.276 0.587 0.001* Hand movement 1.343 0.999 1.807 0.051 Light perception 0.511 0.358 0.729 0.001* No light perception 0.404 0.067 2.429 0.306 IOP (mmHg) ≤6 0.790 0.599 1.041 0.094 7~10 1.288 0.970 1.710 0.081 11~15 0.984 0.644 1.503 0.984 16~21 0.929 0.437 1.977 0.849 21 1.219 0.262 5.677 0.801 Macular status Macular hole 3.064 1.859 4.992 0.001* Detachment without macular hole 0.591 0.288 1.212 0.147 Detachment with macular hole 3.064 1.859 4.992 .001* No detachment 0.591 0.288 1.212 0.147 Axial length (mm) 24 1.459 0.852 2.498 0.167 2426 1.209 0.859 1.702 0.275 2630 1.307 0.981 1.743 0.067 30 0.573 0.430 0.764 0.001* Operation mode PPV+silicone oil 1.333 0.941 1.887 0.105 PPV+gas 0.683 0.312 1.696 0.341 Scleral buckling 0.641 0.433 0.947 0.025* PPV+encircling band 2.665 0.805 8.819 0.095 Abbreviations: BCVA, best-corrected visual acuity; IOP, intraocular pressure; PPV, pars plana vitrectomy.
Multivariate logistic regression analyses showed significant differences in male, age, BCVA, AL, macular hole with detachment, and scleral buckling (Table 3). The incidence of retinal redetachment was significantly lower (P0.001) in patients with lower AL (AL26 mm) than in patients with longer AL (AL≥26 mm), was significantly higher (P=0.011) in patients with poor BCVA (0.05) than in patients with BCVA, and was significantly lower (P0.001) in patients with retinal reattachment than in patients with macular hole with detachment. Regarding the first operation mode, the incidence of recurrence retinal redetachment in RRD-CD patients undergoing SB was significantly higher than that in PPV (P=0.031). 74.62% of the patients had recurrent retinal redetachment within 3 months after the first operation, 84.3% of the patients had recurrent retinal redetachment within 6 months after the first operation, and 92.3% of the patients had recurrent retinal redetachment within 12 months after the first operation.
Table 3 Multivariate Logistic Regression Analysis of Risk Factors for Recurrence Retinal Detachment B Standard Error Wald Odds Ratio (95% Confidence Interval) Sex (male) −1.48 0.69 4.67 4.40 (1.15-16.90) Age (40 years) −4.45 1.35 9.27 0.01 (0.00-0.21) BCVA0.05 −1.65 0.66 7.51 0.20 (0.06-0.69) IOP10 mmHg
-0.01 0.00 2.29 1.00 (0.99-1.00) Detachment with macular hole 0.50 0.54 0.83 1.64 (0.57-4.75) Axial length≥26 mm
-3.49 0.71 24.23 0.03 (0.01-0.12) Lens (aphakic/pseudophakic) 0.56 0.51 1.19 1.75 (0.64-4.78) Operation mode PPV+silicone oil 0.21 0.52 0.17 1.24 (0.45-3.39) PPV+gas
-0.01 0.02 0.11 0.99 (0.96-1.03) Scleral buckling −1.48 0.67 4.15 0.28 (0.07-0.89) PPV+encircling band 0.60 0.72 1.82 0.69 (0.44-7.48) Abbreviations: BCVA, best-corrected visual acuity; IOP, intraocular pressure; PPV, pars plana vitrectomy.
Discussion RRD-CD is an unusual severe type of rhegmatogenous retinal detachment, and the prognosis is poor due to rapid onset of massive vitreous and peri-retinal proliferation.1 Up to 10% of RRD cases require additional interventions to repair recurrent detachment, and remain a significant challenge for vitreoretinal surgeons and the patients.9 Despite recent developments in microincision vitrectomy system, perfluorocarbon liquids, and intraocular tamponades for the managing of RRD-CD, we need to identify risk factors for RRD-CD to improve the prognosis of RRD-CD.
In the present study, we analyzed clinical features of RRD-CD patients, and focused on risk factors of recurrent retinal detachment, which is helpful to screen high-risk populations of RRD-CD and reduce the blindness rate of the disease. Based on the analysis of 15-year data, we found that the rate of RRD-CD was higher in males than in females, but was not different between left and right eyes. Yu et al reported that although the proportion of males was higher than that of females, the proportion of males was only 53%, lower than that of males in our study.3 However, in the study by Denwattana et al, the proportion of males was as high as 78%, higher than the rate in our study.10 In the present study, the average age of the patients was 48.51 years. The 40-59 age group accounted for 42.8% (516 cases; Figure 1). It is known that retinal detachment is more common in people over 50 years old, and 66% of RRD-CD patients were older than 50 years and the rate of RRD-CD in the 50-59 year old age group was the highest.11 We think that the differences in the age in different studies were due to geographical and ethnic differences, and different sample size.
In the present study, myopia accounted for 92.6% (high myopia: AL26 mm about 69.0%) and the incidence of RRD-CD increased with AL, consistent with previous studies.3,4,11 We found that approximately 42.33% of patients with RRD-CD presented with IOP of 0-6 mmHg and more than 83% of patients had IOP lower than 10 mmHg. The current standard for low IOP in RRD-CD patients is 4 mmHg. However, more than 15% of patients had normal IOP.
Therefore, hypotension is an important but not necessary indication in RRD-CD diagnosis.
Approximately 28.3% of patients with RRD-CD in our study had cataract surgery history, 20.96% of them had intraocular lens, and 7.34% had aphakia. The proportion of pseudophakic reported by Denwattana et al was higher than that of this study (46.05%), but the proportion of aphakic eyes was similar to our study.10 The proportion of pseudophakic/aphakic reported by Yu et al was lower than that reported in this study (10.95%).4 We presumed that this discrepancy might be due to the differences in the time to visit from the onset of symptoms.
The success rate of surgery for RRD-CD is less than 70%, far less than the rate for RRD patients without CD.11-13 In this study, the rate of RRD-CD patients with total retinal reattachment 3 months after surgery and without retinal redetachment 1 year after surgery was 78.71%, higher than the rate reported previously.11,12 Because this study excluded patients who had a recurrence after the first operation in other hospitals and the success of RRD-CD therapy has been improved with the vitrectomy technique, this may be the reason why the recurrence rate is lower than that of other studies.
In the present study, we found that SB was the preferred operation at the beginning of the study period, but PPV gained more attention later. The majority of retinal redetachment occurred within the first 3 months. Among 1004 patients operated with PPV with oil, 205 cases (20.4%) subsequently underwent redetachment surgery, while among 144 patients operated with SB, 41 cases (28.5%) subsequently underwent redetachment surgery. Therefore, scleral buckling is an important risk factor for recurrence. The retinal reattachment rate of vitreous surgery in RRD-CD patients is high, and the recurrence rate is lower than that of scleral buckling.14 Therefore, we think that SB may lead to complications, which increase the rate of recurrence retinal detachment.
We found that risk factors for recurrence retinal detachment after first surgery included male, middle age, and high myopia. The average age of the recurrence group was 45.05±13.42 years, significantly less than that of the non-recurrence group. In previous studies, most patients were old.3-5 The difference in age may lead to different outcomes. Notably, we found that the rate of recurrence of retinal detachment was significantly higher in males than in females. The differences in the anatomy of the eye and vitreous between males and females may explain the increased risk of recurrence retinal detachment in males. Males have longer axial length while females tend toward early posterior vitreous detachment, which may confer protection for recurrence retinal detachment.15 In the present study, the proportion of aphakic eyes was higher in the recurrent group than in the non-recurrence group, but the difference was not statistically significant, consistent with a previous study showing that macular hole was a risk factor for RRD-CD.16 However, in our study the proportion of RRD-CD patents with macular detachment and hole was significantly lower in the recurrent group than in the non-recurrence group. Any retinal detachment causes the alterations in retinal microstructure.17,18 Therefore, reducing the risk of redetachment helps recover visual acuity of the patients.
This study has several limitations. While we focused on the risk factors of recurrent retinal detachment after first surgery, the redetachment was not operated in a minor part of the patients because they refused the surgery due to financial difficulty or risk management; this may cause a bias for the inclusion of patients for final analysis. Another limitation is that we did not analyze the location, shape, and number of retinal breaks due to the lack of sufficient data from each patient, and could not analyze the classification of PVD.
In conclusion, this retrospective study showed that the risk factors of recurrent retinal detachment after first surgery for patients with RRD-CD were male, middle age, poor preoperative vision, and longer axial length patients with RRD-CD. Scleral buckling was an independent risk factor for retinal redetachment.
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As a general rule, retinal detachment occurs in both eyes in about one in ten patients with an initial retinal detachment in one eye. The second detachment in the fellow eye may occur even years later.
Thus it is clear that retinal detachment may occur again even after a year. But in this case the concerned Dr who performed the first operation for retinal attachmenton 17 May 2017. The second surgery was performed on 28 June 2017 by the same Dr. Both the surgeries were performed by the opposite party. After second surgery the complainant could not get relief and thereafter he went to Shroff Eye Clinic New Delhi and undergone for another surgery on 17 August 2017. It means that within two months that complaint has to undergo the third eye surgery. The opposite party has stated that the complainant came for his treatment of retina and was diagnosed to be suffering from partial Rhegmatogenous retinal detachment.
Rhegmatogenous retinal detachment is the most common type of retinal detachment. It can happen if you have a small tear or break in your retina. When your retina has a tear or break, the gel-like fluid in the center of your eye (called vitreous) can get behind your retina.
Retinal detachment is a condition in which the neurosensory retina is separated from the retinal pigment epithelium. If untreated, permanent loss of vision may occur. Types of retinal detachment include rhegmatogenous, exudative, tractional, combined tractional-rhegmatogenous, and macular hole-associated detachment. Rhegmatogenous retinal detachment (RRD) is the most common of these. Part 1 of this 2-part article covers RRD risk factors, features, and examination. Next month, part 2 covers management.
RRD. Macula-off primary rhegmatogenous retinal detachment with multiple breaks located within 1.5 clock hours of the highest border of the detachment (consistent with Lincoff rules).
Defining RRD The word rhegmatogenous is derived from the Greek word rhegma, which means broken. The pathogenesis of RRD involves vitreoretinal tractional forces that result in a full-thickness retinal break. Liquefied vitreous gel then enters the subretinal space through the break, causing separation of the neurosensory retina from the underlying retinal pigment epithelium.1 Total RRD denotes separation of the entire retina; subtotal RRD refers to detachment of most of it. Subclinical retinal detachments are those with subretinal fluid extending more than 1 disc diameter from the break but less than 2 disc diameters posterior to the equator. If subretinal fluid extends less than 1 disc diameter, the condition is defined as a retinal break without detachment.2 AMSLER-DUBOIS RETINAL CHART. The innermost circle represents the equator, the middle circle represents the ora serrata (scalloped edges), and the outermost circle represents the junction of the pars plana and pars plicata. Lesions commonly associated with RRD are marked: a horseshoe tear (2 o'clock position) with a torn vessel, a resultant retinal detachment (extending through 3 clock hours), lattice degeneration (8 o'clock), and vitreous hemorrhage inferiorly (green area).
Risk Factors Risk factors for RRD include high myopia, trauma to the eye or head, RRD in the fellow eye, underlying hereditary vitreoretinopathy, previous intraocular surgeries, and previous viral retinitis. Other risk factors are intraocular procedures (especially vitreous manipulation), laser capsulotomy, pseudophakia/aphakia,3 and retinal lesions such as lattice degeneration, snail track degeneration, snowflake degeneration, vitreoretinal tufts, meridional folds, retinoschisis, and white lesions (with or without pressure).2 TOTAL RETINAL DETACHMENT. Ultrasound A-scan and B-scan of an eye with total retinal detachment, resulting in a funnel-shaped configuration. A hyperechogenic interface can be seen in the vitreous cavity on the B-scan (black-and-white image). This interface has a high-amplitude A-scan spike (blue line) that reaches the posterior sclera, suggesting that the interface is retinal tissue. If the A-scan spike of a hyperechogenic focus within the vitreous is of low amplitude, it is more likely to indicate posterior vitreous face, vitreous hemorrhage, or vitritis, depending on the clinical picture. In a rhegmatogenous detachment, the hyperechogenic interface of the high-amplitude A-scan spike should undulate with eye movement, whereas cases with PVR or tractional retinal detachment will demonstrate reduced mobility of the retinal interface.
Clinical Features Patients with RRD may present with floaters, photopsia, and/or a "curtain" defect that obscures part of the visual field. Visual acuity (VA) ranges from excellent to poor, depending on whether the macula is still attached. In patients with macula-off RRD, vision usually is decreased. If the area of detachment is large, an afferent pupillary defect may be present.
Intraocular pressure (IOP) can be low or high. Low IOP results from increased outflow of intraocular fluid through the subretinal space and peripapillary connective tissue, particularly if the optic disc border is involved. High IOP may occur with chronic RRD, in which photoreceptor outer segments transgress into the anterior chamber and trabecular meshwork, impeding aqueous outflow. This is also known as Schwartz-Matsuo syndrome. Other features of chronic RRD may include a pigmented demarcation line at the detachment border, intraretinal macrocysts, atrophic thinned retina, subretinal white precipitates, and signs of proliferative vitreoretinopathy (PVR), such as fixed retinal folds.
Assessment of RRD requires a thorough 360-degree fundus examination. When visualization of the fundus is poor, as in patients with dense cataract or vitreous hemorrhage, an ultrasound B-scan may be useful.
Lincoff Rules: Finding the Break in Primary RRD Rule 1. In superior-temporal or superior-nasal detachments: The primary break is within 1.5 clock hours of the highest border (in 98% of cases).
Rule 2. In total detachments or superior detachments that cross the 12 o'clock meridian (vertically above the disc): The primary break is at 12 o'clock or the break is a triangle with the apex at the ora serrata and the base at the equator, extending from 11 to 1 o'clock (in 93% of cases).
Rule 3. In inferior detachments: The higher side of the detachment indicates the side of the disc where the primary break lies, and the break is found below the horizontal meridian (in 95% of cases).
However, in inferior detachments where right/left borders are equally high, the break is in the inferior retina at 6 o'clock.
Rule 4. In inferior bullous detachments: The primary break is located above the horizontal meridian.
SOURCE: Lincoff H, Gieser R. Arch Ophthalmol. 1971;85(5):565-569.
Examination Binocular indirect ophthalmoscopy (BIO) of the fundus. BIO with a lens of 20 or 28 D allows visualization of the peripheral retina. For some eyes, scleral depression during indirect ophthalmoscopy or contact fundus lens examination using the slit lamp (e.g., Goldmann 3-mirror lens) may help view smaller peripheral retinal breaks.
Examination. This should include the following steps:
Identify the extent of detachment. The detached area will appear opaque and corrugated, with undulating retinal folds during eye movement. The borders of the detached tissue usually are convex, and the subretinal fluid is clear and nonshifting. (See "Differentiating the Main Types of Retinal Detachment," for pearls to differentiate tractional and exudative retinal detachment from RRD.) Other features that may accompany RRD include a positive Shafer's sign (pigment in the anterior vitreous), vitreous hemorrhage, and lower IOP than in the fellow eye.
Find all retinal breaks, which will help guide the surgical approach. It is important to note the size, number, and location of each break. Lincoff rules are useful for identifying the precise location of the retinal break in cases of primary RRD.3 If there are multiple breaks, the highest retinal hole is considered the primary hole. (See "Lincoff Rules.")The location of retinal detachment plays a major role in management and prognosis.
Determine whether the RRD is macula-on or macula-off (Fig. 1). Although visual prognosis is much better for macula-on RRD that spares the fovea, urgent intervention is still needed.
Check for associated features. Retinal lesions that predispose to retinal breaks, such as lattice degeneration, should be identified. Also look for features that might affect management and prognosis, such as coexisting vitreous hemorrhage and PVR.
Document the findings on an Amsler-Dubois chart or in the electronic medical record, using color codes and symbols to represent retinal lesions (Fig. 2).
Ultrasonography. If the fundus view is obscured, dynamic B-scan ultrasonography is helpful to confirm RRD and determine the status of macular involvement, presence of posterior vitreous detachment, location of retinal break (occasionally), and chronicity of RRD (mobile or fixed).
Typical ultrasound findings for RRD include high reflectivity, a high spike on the A-scan, a membrane within the vitreous cavity, and mobility during eye movements. Posterior vitreous detachment is characterized by a posterior hyaloid face, low reflectivity, a low spike on the A-scan, and a high degree of mobility during eye movements (Fig. 3, demonstrates the ultrasound appearance of a funnel retinal detachment).
___________________________ Acknowledgment: The authors thank the Ocular Imaging Department, Singapore National Eye Centre, for providing the retinal photographs, including the B-scan ultrasonography image.
___________________________ 1 Kuhn F, Aylward B. Ophthalmic Res. 2014;51(1):15-31.
2 Schubert HD et al. Retinal detachment and predisposing lesions. Retina and Vitreous. San Francisco: American Academy of Ophthalmology; 2016-2017.
3 Lincoff H, Gieser R. Arch Ophthalmol. 1971;85(5):565-569.
Now we can see the table showing difference between the main type of retinal detachment.
After going through the different medical articles and the documents filed by the parties we are of the opinion that retina may be detached after re-attachment. There is nothing special about retina detachment and attachment. The complainant failed to show any negligence or deficiency of service on the part of the opposite parties. Retina detachment after attachment is a natural phenomena and it is based on so many reasons and one is lying on a bed on one side for some days. The procedure adopted was as per medical protocol and it cannot be said that there is any carelessness on the part of the opposite parties. So the present complaint is liable to dismissed.
ORDER The complaint is dismissed with costs.
The stenographer is requested to upload this order on the Website of this Commission today itself.
Certified copy of this judgment be provided to the parties as per rules.
(Sushil Kumar) (Rajendra Singh) Member Presiding Member Judgment dated/typed signed by us and pronounced in the open court. Consign to record. (Sushil Kumar) (Rajendra Singh) Member Presiding Member Dated April 5, 2023 JafRi, PA II , Court 2 [HON'BLE MR. Rajendra Singh] PRESIDING MEMBER [HON'BLE MR. SUSHIL KUMAR] JUDICIAL MEMBER